HB1565 EngrossedLRB103 25816 BMS 52167 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The State Employees Group Insurance Act of 1971
5is amended by changing Section 6.11 as follows:
 
6    (5 ILCS 375/6.11)
7    (Text of Section before amendment by P.A. 102-768)
8    Sec. 6.11. Required health benefits; Illinois Insurance
9Code requirements. The program of health benefits shall
10provide the post-mastectomy care benefits required to be
11covered by a policy of accident and health insurance under
12Section 356t of the Illinois Insurance Code. The program of
13health benefits shall provide the coverage required under
14Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
15356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
16356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
17356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
18356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
19356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60, and
20356z.61 of the Illinois Insurance Code. The program of health
21benefits must comply with Sections 155.22a, 155.37, 355b,
22356z.19, 370c, and 370c.1 and Article XXXIIB of the Illinois
23Insurance Code. The Department of Insurance shall enforce the

 

 

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1requirements of this Section with respect to Sections 370c and
2370c.1 of the Illinois Insurance Code; all other requirements
3of this Section shall be enforced by the Department of Central
4Management Services.
5    Rulemaking authority to implement Public Act 95-1045, if
6any, is conditioned on the rules being adopted in accordance
7with all provisions of the Illinois Administrative Procedure
8Act and all rules and procedures of the Joint Committee on
9Administrative Rules; any purported rule not so adopted, for
10whatever reason, is unauthorized.
11(Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20;
12101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
131-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103,
14eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
15102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
161-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
17eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
18revised 12-13-22.)
 
19    (Text of Section after amendment by P.A. 102-768)
20    Sec. 6.11. Required health benefits; Illinois Insurance
21Code requirements. The program of health benefits shall
22provide the post-mastectomy care benefits required to be
23covered by a policy of accident and health insurance under
24Section 356t of the Illinois Insurance Code. The program of
25health benefits shall provide the coverage required under

 

 

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1Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
2356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
3356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
4356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
5356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
6356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, and
7356z.60, and 356z.61 of the Illinois Insurance Code. The
8program of health benefits must comply with Sections 155.22a,
9155.37, 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of
10the Illinois Insurance Code. The Department of Insurance shall
11enforce the requirements of this Section with respect to
12Sections 370c and 370c.1 of the Illinois Insurance Code; all
13other requirements of this Section shall be enforced by the
14Department of Central Management Services.
15    Rulemaking authority to implement Public Act 95-1045, if
16any, is conditioned on the rules being adopted in accordance
17with all provisions of the Illinois Administrative Procedure
18Act and all rules and procedures of the Joint Committee on
19Administrative Rules; any purported rule not so adopted, for
20whatever reason, is unauthorized.
21(Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20;
22101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
231-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103,
24eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
25102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
261-1-23; 102-768, eff. 1-1-24; 102-804, eff. 1-1-23; 102-813,

 

 

HB1565 Engrossed- 4 -LRB103 25816 BMS 52167 b

1eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, eff. 1-1-23;
2102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
 
3    Section 10. The Counties Code is amended by changing
4Section 5-1069.3 as follows:
 
5    (55 ILCS 5/5-1069.3)
6    Sec. 5-1069.3. Required health benefits. If a county,
7including a home rule county, is a self-insurer for purposes
8of providing health insurance coverage for its employees, the
9coverage shall include coverage for the post-mastectomy care
10benefits required to be covered by a policy of accident and
11health insurance under Section 356t and the coverage required
12under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356w, 356x,
13356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
14356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
15356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40,
16356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53,
17356z.54, 356z.56, 356z.57, 356z.59, and 356z.60, and 356z.61
18of the Illinois Insurance Code. The coverage shall comply with
19Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
20Insurance Code. The Department of Insurance shall enforce the
21requirements of this Section. The requirement that health
22benefits be covered as provided in this Section is an
23exclusive power and function of the State and is a denial and
24limitation under Article VII, Section 6, subsection (h) of the

 

 

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1Illinois Constitution. A home rule county to which this
2Section applies must comply with every provision of this
3Section.
4    Rulemaking authority to implement Public Act 95-1045, if
5any, is conditioned on the rules being adopted in accordance
6with all provisions of the Illinois Administrative Procedure
7Act and all rules and procedures of the Joint Committee on
8Administrative Rules; any purported rule not so adopted, for
9whatever reason, is unauthorized.
10(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
11101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
121-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
13eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
14102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
151-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
16eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
17102-1117, eff. 1-13-23.)
 
18    Section 15. The Illinois Municipal Code is amended by
19changing Section 10-4-2.3 as follows:
 
20    (65 ILCS 5/10-4-2.3)
21    Sec. 10-4-2.3. Required health benefits. If a
22municipality, including a home rule municipality, is a
23self-insurer for purposes of providing health insurance
24coverage for its employees, the coverage shall include

 

 

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1coverage for the post-mastectomy care benefits required to be
2covered by a policy of accident and health insurance under
3Section 356t and the coverage required under Sections 356g,
4356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.4, 356z.4a,
5356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
6356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
7356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
8356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
9356z.56, 356z.57, 356z.59, and 356z.60, and 356z.61 of the
10Illinois Insurance Code. The coverage shall comply with
11Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
12Insurance Code. The Department of Insurance shall enforce the
13requirements of this Section. The requirement that health
14benefits be covered as provided in this is an exclusive power
15and function of the State and is a denial and limitation under
16Article VII, Section 6, subsection (h) of the Illinois
17Constitution. A home rule municipality to which this Section
18applies must comply with every provision of this Section.
19    Rulemaking authority to implement Public Act 95-1045, if
20any, is conditioned on the rules being adopted in accordance
21with all provisions of the Illinois Administrative Procedure
22Act and all rules and procedures of the Joint Committee on
23Administrative Rules; any purported rule not so adopted, for
24whatever reason, is unauthorized.
25(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
26101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.

 

 

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11-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
2eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
3102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
41-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
5eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
6102-1117, eff. 1-13-23.)
 
7    Section 20. The School Code is amended by changing Section
810-22.3f as follows:
 
9    (105 ILCS 5/10-22.3f)
10    Sec. 10-22.3f. Required health benefits. Insurance
11protection and benefits for employees shall provide the
12post-mastectomy care benefits required to be covered by a
13policy of accident and health insurance under Section 356t and
14the coverage required under Sections 356g, 356g.5, 356g.5-1,
15356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8,
16356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
17356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
18356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
19356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60, and
20356z.61 of the Illinois Insurance Code. Insurance policies
21shall comply with Section 356z.19 of the Illinois Insurance
22Code. The coverage shall comply with Sections 155.22a, 355b,
23and 370c of the Illinois Insurance Code. The Department of
24Insurance shall enforce the requirements of this Section.

 

 

HB1565 Engrossed- 8 -LRB103 25816 BMS 52167 b

1    Rulemaking authority to implement Public Act 95-1045, if
2any, is conditioned on the rules being adopted in accordance
3with all provisions of the Illinois Administrative Procedure
4Act and all rules and procedures of the Joint Committee on
5Administrative Rules; any purported rule not so adopted, for
6whatever reason, is unauthorized.
7(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
8101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
91-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
10eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. 1-1-22;
11102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804, eff.
121-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860,
13eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
 
14    Section 25. The Illinois Insurance Code is amended by
15adding Section 356z.61 as follows:
 
16    (215 ILCS 5/356z.61 new)
17    Sec. 356z.61. Coverage of prescription estrogen.
18    (a) A group or individual policy of accident and health
19insurance or a managed care plan that is amended, delivered,
20issued, or renewed on or after January 1, 2025 and that
21provides coverage for prescription drugs shall include
22coverage for one or more therapeutic equivalent versions of
23vaginal estrogen in its formulary. A policy is not required to
24include all therapeutic equivalent versions of vaginal

 

 

HB1565 Engrossed- 9 -LRB103 25816 BMS 52167 b

1estrogen in its formulary so long as at least one is included
2and covered without cost sharing and in accordance with this
3Section.
4    (b) If an individual's attending provider recommends a
5particular vaginal estrogen product or its therapeutic
6equivalent version approved by the United States Food and Drug
7Administration based on the provider's determination, the
8issuer must cover that service or item without cost sharing.
9    (c) A policy subject to this Section shall not impose a
10deductible, coinsurance, copayment, or any other cost-sharing
11requirement on the coverage provided; except that this
12subsection does not apply to coverage of vaginal estrogen to
13the extent such coverage would disqualify a high-deductible
14health plan from eligibility for a health savings account
15pursuant to Section 223 of the Internal Revenue Code.
16    (d) As used in this Section, "therapeutic equivalent
17version" has the meaning given to that term in paragraph (2) of
18subsection (a) of Section 356z.4.
 
19    Section 30. The Health Maintenance Organization Act is
20amended by changing Section 5-3 as follows:
 
21    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
22    Sec. 5-3. Insurance Code provisions.
23    (a) Health Maintenance Organizations shall be subject to
24the provisions of Sections 133, 134, 136, 137, 139, 140,

 

 

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1141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
2154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
3355.3, 355b, 355c, 356g.5-1, 356m, 356q, 356v, 356w, 356x,
4356y, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
5356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
6356z.15, 356z.17, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
7356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
8356z.35, 356z.36, 356z.40, 356z.41, 356z.46, 356z.47, 356z.48,
9356z.50, 356z.51, 356z.53 256z.53, 356z.54, 356z.56, 356z.57,
10356z.59, 356z.60, 356z.61, 364, 364.01, 364.3, 367.2, 367.2-5,
11367i, 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1,
12402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1,
13paragraph (c) of subsection (2) of Section 367, and Articles
14IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and
15XXXIIB of the Illinois Insurance Code.
16    (b) For purposes of the Illinois Insurance Code, except
17for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
18Health Maintenance Organizations in the following categories
19are deemed to be "domestic companies":
20        (1) a corporation authorized under the Dental Service
21    Plan Act or the Voluntary Health Services Plans Act;
22        (2) a corporation organized under the laws of this
23    State; or
24        (3) a corporation organized under the laws of another
25    state, 30% or more of the enrollees of which are residents
26    of this State, except a corporation subject to

 

 

HB1565 Engrossed- 11 -LRB103 25816 BMS 52167 b

1    substantially the same requirements in its state of
2    organization as is a "domestic company" under Article VIII
3    1/2 of the Illinois Insurance Code.
4    (c) In considering the merger, consolidation, or other
5acquisition of control of a Health Maintenance Organization
6pursuant to Article VIII 1/2 of the Illinois Insurance Code,
7        (1) the Director shall give primary consideration to
8    the continuation of benefits to enrollees and the
9    financial conditions of the acquired Health Maintenance
10    Organization after the merger, consolidation, or other
11    acquisition of control takes effect;
12        (2)(i) the criteria specified in subsection (1)(b) of
13    Section 131.8 of the Illinois Insurance Code shall not
14    apply and (ii) the Director, in making his determination
15    with respect to the merger, consolidation, or other
16    acquisition of control, need not take into account the
17    effect on competition of the merger, consolidation, or
18    other acquisition of control;
19        (3) the Director shall have the power to require the
20    following information:
21            (A) certification by an independent actuary of the
22        adequacy of the reserves of the Health Maintenance
23        Organization sought to be acquired;
24            (B) pro forma financial statements reflecting the
25        combined balance sheets of the acquiring company and
26        the Health Maintenance Organization sought to be

 

 

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1        acquired as of the end of the preceding year and as of
2        a date 90 days prior to the acquisition, as well as pro
3        forma financial statements reflecting projected
4        combined operation for a period of 2 years;
5            (C) a pro forma business plan detailing an
6        acquiring party's plans with respect to the operation
7        of the Health Maintenance Organization sought to be
8        acquired for a period of not less than 3 years; and
9            (D) such other information as the Director shall
10        require.
11    (d) The provisions of Article VIII 1/2 of the Illinois
12Insurance Code and this Section 5-3 shall apply to the sale by
13any health maintenance organization of greater than 10% of its
14enrollee population (including without limitation the health
15maintenance organization's right, title, and interest in and
16to its health care certificates).
17    (e) In considering any management contract or service
18agreement subject to Section 141.1 of the Illinois Insurance
19Code, the Director (i) shall, in addition to the criteria
20specified in Section 141.2 of the Illinois Insurance Code,
21take into account the effect of the management contract or
22service agreement on the continuation of benefits to enrollees
23and the financial condition of the health maintenance
24organization to be managed or serviced, and (ii) need not take
25into account the effect of the management contract or service
26agreement on competition.

 

 

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1    (f) Except for small employer groups as defined in the
2Small Employer Rating, Renewability and Portability Health
3Insurance Act and except for medicare supplement policies as
4defined in Section 363 of the Illinois Insurance Code, a
5Health Maintenance Organization may by contract agree with a
6group or other enrollment unit to effect refunds or charge
7additional premiums under the following terms and conditions:
8        (i) the amount of, and other terms and conditions with
9    respect to, the refund or additional premium are set forth
10    in the group or enrollment unit contract agreed in advance
11    of the period for which a refund is to be paid or
12    additional premium is to be charged (which period shall
13    not be less than one year); and
14        (ii) the amount of the refund or additional premium
15    shall not exceed 20% of the Health Maintenance
16    Organization's profitable or unprofitable experience with
17    respect to the group or other enrollment unit for the
18    period (and, for purposes of a refund or additional
19    premium, the profitable or unprofitable experience shall
20    be calculated taking into account a pro rata share of the
21    Health Maintenance Organization's administrative and
22    marketing expenses, but shall not include any refund to be
23    made or additional premium to be paid pursuant to this
24    subsection (f)). The Health Maintenance Organization and
25    the group or enrollment unit may agree that the profitable
26    or unprofitable experience may be calculated taking into

 

 

HB1565 Engrossed- 14 -LRB103 25816 BMS 52167 b

1    account the refund period and the immediately preceding 2
2    plan years.
3    The Health Maintenance Organization shall include a
4statement in the evidence of coverage issued to each enrollee
5describing the possibility of a refund or additional premium,
6and upon request of any group or enrollment unit, provide to
7the group or enrollment unit a description of the method used
8to calculate (1) the Health Maintenance Organization's
9profitable experience with respect to the group or enrollment
10unit and the resulting refund to the group or enrollment unit
11or (2) the Health Maintenance Organization's unprofitable
12experience with respect to the group or enrollment unit and
13the resulting additional premium to be paid by the group or
14enrollment unit.
15    In no event shall the Illinois Health Maintenance
16Organization Guaranty Association be liable to pay any
17contractual obligation of an insolvent organization to pay any
18refund authorized under this Section.
19    (g) Rulemaking authority to implement Public Act 95-1045,
20if any, is conditioned on the rules being adopted in
21accordance with all provisions of the Illinois Administrative
22Procedure Act and all rules and procedures of the Joint
23Committee on Administrative Rules; any purported rule not so
24adopted, for whatever reason, is unauthorized.
25(Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
26101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-393, eff.

 

 

HB1565 Engrossed- 15 -LRB103 25816 BMS 52167 b

11-1-20; 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625,
2eff. 1-1-21; 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
3102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
41-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
5eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
6102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
71-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
8eff. 1-1-23; 102-1117, eff. 1-13-23; revised 1-22-23.)
 
9    Section 35. The Limited Health Service Organization Act is
10amended by changing Section 4003 as follows:
 
11    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
12    Sec. 4003. Illinois Insurance Code provisions. Limited
13health service organizations shall be subject to the
14provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
15141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
16154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3,
17355b, 356q, 356v, 356z.4, 356z.4a, 356z.10, 356z.21, 356z.22,
18356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
19356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, 356z.57,
20356z.59, 356z.61, 364.3, 368a, 401, 401.1, 402, 403, 403A,
21408, 408.2, 409, 412, 444, and 444.1 and Articles IIA, VIII
221/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the
23Illinois Insurance Code. Nothing in this Section shall require
24a limited health care plan to cover any service that is not a

 

 

HB1565 Engrossed- 16 -LRB103 25816 BMS 52167 b

1limited health service. For purposes of the Illinois Insurance
2Code, except for Sections 444 and 444.1 and Articles XIII and
3XIII 1/2, limited health service organizations in the
4following categories are deemed to be domestic companies:
5        (1) a corporation under the laws of this State; or
6        (2) a corporation organized under the laws of another
7    state, 30% or more of the enrollees of which are residents
8    of this State, except a corporation subject to
9    substantially the same requirements in its state of
10    organization as is a domestic company under Article VIII
11    1/2 of the Illinois Insurance Code.
12(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
13101-393, eff. 1-1-20; 101-625, eff. 1-1-21; 102-30, eff.
141-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642,
15eff. 1-1-22; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
16102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, eff.
171-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
 
18    Section 40. The Voluntary Health Services Plans Act is
19amended by changing Section 10 as follows:
 
20    (215 ILCS 165/10)  (from Ch. 32, par. 604)
21    Sec. 10. Application of Insurance Code provisions. Health
22services plan corporations and all persons interested therein
23or dealing therewith shall be subject to the provisions of
24Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,

 

 

HB1565 Engrossed- 17 -LRB103 25816 BMS 52167 b

1143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
2356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w,
3356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5,
4356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
5356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
6356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
7356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
8356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 364.01, 364.3,
9367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
10and paragraphs (7) and (15) of Section 367 of the Illinois
11Insurance Code.
12    Rulemaking authority to implement Public Act 95-1045, if
13any, is conditioned on the rules being adopted in accordance
14with all provisions of the Illinois Administrative Procedure
15Act and all rules and procedures of the Joint Committee on
16Administrative Rules; any purported rule not so adopted, for
17whatever reason, is unauthorized.
18(Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
19101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff.
201-1-21; 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 102-306,
21eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21;
22102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804, eff.
231-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860,
24eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff. 1-1-23;
25102-1117, eff. 1-13-23.)
 

 

 

HB1565 Engrossed- 18 -LRB103 25816 BMS 52167 b

1    Section 45. The Illinois Public Aid Code is amended by
2changing Section 5-16.8 as follows:
 
3    (305 ILCS 5/5-16.8)
4    Sec. 5-16.8. Required health benefits. The medical
5assistance program shall (i) provide the post-mastectomy care
6benefits required to be covered by a policy of accident and
7health insurance under Section 356t and the coverage required
8under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
9356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
10356z.47, 356z.51, 356z.53, 356z.56, 356z.59, and 356z.60, and
11356z.61 of the Illinois Insurance Code, (ii) be subject to the
12provisions of Sections 356z.19, 356z.44, 356z.49, 364.01,
13370c, and 370c.1 of the Illinois Insurance Code, and (iii) be
14subject to the provisions of subsection (d-5) of Section 10 of
15the Network Adequacy and Transparency Act.
16    The Department, by rule, shall adopt a model similar to
17the requirements of Section 356z.39 of the Illinois Insurance
18Code.
19    On and after July 1, 2012, the Department shall reduce any
20rate of reimbursement for services or other payments or alter
21any methodologies authorized by this Code to reduce any rate
22of reimbursement for services or other payments in accordance
23with Section 5-5e.
24    To ensure full access to the benefits set forth in this
25Section, on and after January 1, 2016, the Department shall

 

 

HB1565 Engrossed- 19 -LRB103 25816 BMS 52167 b

1ensure that provider and hospital reimbursement for
2post-mastectomy care benefits required under this Section are
3no lower than the Medicare reimbursement rate.
4(Source: P.A. 101-81, eff. 7-12-19; 101-218, eff. 1-1-20;
5101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-574, eff.
61-1-20; 101-649, eff. 7-7-20; 102-30, eff. 1-1-22; 102-144,
7eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
8102-530, eff. 1-1-22; 102-642, eff. 1-1-22; 102-804, eff.
91-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093,
10eff. 1-1-23; 102-1117, eff. 1-13-23.)
 
11    Section 95. No acceleration or delay. Where this Act makes
12changes in a statute that is represented in this Act by text
13that is not yet or no longer in effect (for example, a Section
14represented by multiple versions), the use of that text does
15not accelerate or delay the taking effect of (i) the changes
16made by this Act or (ii) provisions derived from any other
17Public Act.