SB2744 EngrossedLRB103 35050 RPS 64995 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    Sec. 6.11. Required health benefits; Illinois Insurance
8Code requirements. The program of health benefits shall
9provide the post-mastectomy care benefits required to be
10covered by a policy of accident and health insurance under
11Section 356t of the Illinois Insurance Code. The program of
12health benefits shall provide the coverage required under
13Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
14356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
15356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
16356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
17356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
18356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, 356z.60,
19and 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, 356z.70,
20and 356z.71 of the Illinois Insurance Code. The program of
21health benefits must comply with Sections 155.22a, 155.37,
22355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of the
23Illinois Insurance Code. The program of health benefits shall

 

 

SB2744 Engrossed- 2 -LRB103 35050 RPS 64995 b

1provide the coverage required under Section 356m of the
2Illinois Insurance Code and, for the employees of the State
3Employee Group Insurance Program only, the coverage as also
4provided in Section 6.11B of this Act. The Department of
5Insurance shall enforce the requirements of this Section with
6respect to Sections 370c and 370c.1 of the Illinois Insurance
7Code; all other requirements of this Section shall be enforced
8by the Department of Central Management Services.
9    Rulemaking authority to implement Public Act 95-1045, if
10any, is conditioned on the rules being adopted in accordance
11with all provisions of the Illinois Administrative Procedure
12Act and all rules and procedures of the Joint Committee on
13Administrative Rules; any purported rule not so adopted, for
14whatever reason, is unauthorized.
15(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
16102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
171-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768,
18eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
19102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
201-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84,
21eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24;
22103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff.
238-11-23; revised 8-29-23.)
 
24    Section 10. The Counties Code is amended by changing
25Section 5-1069.3 as follows:
 

 

 

SB2744 Engrossed- 3 -LRB103 35050 RPS 64995 b

1    (55 ILCS 5/5-1069.3)
2    Sec. 5-1069.3. Required health benefits. If a county,
3including a home rule county, is a self-insurer for purposes
4of providing health insurance coverage for its employees, the
5coverage shall include coverage for 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, 356g.5, 356g.5-1, 356q, 356u, 356w, 356x,
9356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
10356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
11356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40,
12356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53,
13356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and
14356z.62, 356z.64, 356z.67, 356z.68, 356z.70, and 356z.71 of
15the Illinois Insurance Code. The coverage shall comply with
16Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
17Insurance Code. The Department of Insurance shall enforce the
18requirements of this Section. The requirement that health
19benefits be covered as provided in this Section is an
20exclusive power and function of the State and is a denial and
21limitation under Article VII, Section 6, subsection (h) of the
22Illinois Constitution. A home rule county to which this
23Section applies must comply with every provision of this
24Section.
25    Rulemaking authority to implement Public Act 95-1045, if

 

 

SB2744 Engrossed- 4 -LRB103 35050 RPS 64995 b

1any, is conditioned on the rules being adopted in accordance
2with all provisions of the Illinois Administrative Procedure
3Act and all rules and procedures of the Joint Committee on
4Administrative Rules; any purported rule not so adopted, for
5whatever reason, is unauthorized.
6(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
7102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
81-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
9eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
10102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
111-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
12eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
13103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
148-29-23.)
 
15    Section 15. The Illinois Municipal Code is amended by
16changing Section 10-4-2.3 as follows:
 
17    (65 ILCS 5/10-4-2.3)
18    Sec. 10-4-2.3. Required health benefits. If a
19municipality, including a home rule municipality, is a
20self-insurer for purposes of providing health insurance
21coverage for its employees, the coverage shall include
22coverage for the post-mastectomy care benefits required to be
23covered by a policy of accident and health insurance under
24Section 356t and the coverage required under Sections 356g,

 

 

SB2744 Engrossed- 5 -LRB103 35050 RPS 64995 b

1356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.4, 356z.4a,
2356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
3356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
4356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
5356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
6356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and 356z.62,
7356z.64, 356z.67, 356z.68, 356z.70, and 356z.71 of the
8Illinois Insurance Code. The coverage shall comply with
9Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
10Insurance Code. The Department of Insurance shall enforce the
11requirements of this Section. The requirement that health
12benefits be covered as provided in this is an exclusive power
13and function of the State and is a denial and limitation under
14Article VII, Section 6, subsection (h) of the Illinois
15Constitution. A home rule municipality to which this Section
16applies must comply with every provision of this Section.
17    Rulemaking authority to implement Public Act 95-1045, if
18any, is conditioned on the rules being adopted in accordance
19with all provisions of the Illinois Administrative Procedure
20Act and all rules and procedures of the Joint Committee on
21Administrative Rules; any purported rule not so adopted, for
22whatever reason, is unauthorized.
23(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
24102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
251-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
26eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;

 

 

SB2744 Engrossed- 6 -LRB103 35050 RPS 64995 b

1102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
21-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
3eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
4103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
58-29-23.)
 
6    Section 20. The School Code is amended by changing Section
710-22.3f as follows:
 
8    (105 ILCS 5/10-22.3f)
9    Sec. 10-22.3f. Required health benefits. Insurance
10protection and benefits for employees shall provide the
11post-mastectomy care benefits required to be covered by a
12policy of accident and health insurance under Section 356t and
13the coverage required under Sections 356g, 356g.5, 356g.5-1,
14356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8,
15356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
16356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
17356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
18356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and
19356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, 356z.70, and
20356z.71 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.

 

 

SB2744 Engrossed- 7 -LRB103 35050 RPS 64995 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. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
8102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
91-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,
10eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
11102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.
121-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,
13eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;
14103-551, eff. 8-11-23; revised 8-29-23.)
 
15    Section 25. The Illinois Insurance Code is amended by
16adding Section 356z.71 as follows:
 
17    (215 ILCS 5/356z.71 new)
18    Sec. 356z.71. Coverage of vaccination administration fees.
19    (a) A group or individual policy of accident and health
20insurance or a managed care plan that is amended, delivered,
21issued, or renewed on or after January 1, 2026 shall provide
22coverage for vaccinations for COVID-19, influenza, and
23respiratory syncytial virus, including the administration of
24the vaccine by a pharmacist or health care provider authorized

 

 

SB2744 Engrossed- 8 -LRB103 35050 RPS 64995 b

1to administer such a vaccine, without imposing a deductible,
2coinsurance, copayment, or any other cost-sharing requirement,
3if the following conditions are met:
4        (1) the vaccine is authorized or licensed by the
5    United States Food and Drug Administration; and
6        (2) the vaccine is ordered and administered according
7    to the Advisory Committee on Immunization Practices
8    standard immunization schedule.
9    (b) If the vaccinations provided for in subsection (a) are
10not otherwise available to be administered by a contracted
11pharmacist or health care provider, the group or individual
12policy of accident and health insurance or a managed care plan
13shall cover the vaccination, including administration fees,
14without imposing a deductible, coinsurance, copayment, or any
15other cost-sharing requirement.
16    (c) The coverage required in this Section does not apply
17to the extent that the coverage would disqualify a
18high-deductible health plan from eligibility for a health
19savings account pursuant to Section 223 of the Internal
20Revenue Code of 1986.
 
21    Section 30. The Health Maintenance Organization Act is
22amended by changing Section 5-3 as follows:
 
23    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
24    Sec. 5-3. Insurance Code provisions.

 

 

SB2744 Engrossed- 9 -LRB103 35050 RPS 64995 b

1    (a) Health Maintenance Organizations shall be subject to
2the provisions of Sections 133, 134, 136, 137, 139, 140,
3141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
4154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49,
5355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356v,
6356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
7356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
8356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21, 356z.22,
9356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29, 356z.30,
10356z.30a, 356z.31, 356z.32, 356z.33, 356z.34, 356z.35,
11356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41, 356z.44,
12356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50, 356z.51,
13356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58, 356z.59,
14356z.60, 356z.61, 356z.62, 356z.64, 356z.65, 356z.67, 356z.68,
15356z.71, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b,
16368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A,
17408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
18subsection (2) of Section 367, and Articles IIA, VIII 1/2,
19XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
20Illinois Insurance Code.
21    (b) For purposes of the Illinois Insurance Code, except
22for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
23Health Maintenance Organizations in the following categories
24are deemed to be "domestic companies":
25        (1) a corporation authorized under the Dental Service
26    Plan Act or the Voluntary Health Services Plans Act;

 

 

SB2744 Engrossed- 10 -LRB103 35050 RPS 64995 b

1        (2) a corporation organized under the laws of this
2    State; or
3        (3) a corporation organized under the laws of another
4    state, 30% or more of the enrollees of which are residents
5    of this State, except a corporation subject to
6    substantially the same requirements in its state of
7    organization as is a "domestic company" under Article VIII
8    1/2 of the Illinois Insurance Code.
9    (c) In considering the merger, consolidation, or other
10acquisition of control of a Health Maintenance Organization
11pursuant to Article VIII 1/2 of the Illinois Insurance Code,
12        (1) the Director shall give primary consideration to
13    the continuation of benefits to enrollees and the
14    financial conditions of the acquired Health Maintenance
15    Organization after the merger, consolidation, or other
16    acquisition of control takes effect;
17        (2)(i) the criteria specified in subsection (1)(b) of
18    Section 131.8 of the Illinois Insurance Code shall not
19    apply and (ii) the Director, in making his determination
20    with respect to the merger, consolidation, or other
21    acquisition of control, need not take into account the
22    effect on competition of the merger, consolidation, or
23    other acquisition of control;
24        (3) the Director shall have the power to require the
25    following information:
26            (A) certification by an independent actuary of the

 

 

SB2744 Engrossed- 11 -LRB103 35050 RPS 64995 b

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

 

 

SB2744 Engrossed- 12 -LRB103 35050 RPS 64995 b

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

 

 

SB2744 Engrossed- 13 -LRB103 35050 RPS 64995 b

1    marketing expenses, but shall not include any refund to be
2    made or additional premium to be paid pursuant to this
3    subsection (f)). The Health Maintenance Organization and
4    the group or enrollment unit may agree that the profitable
5    or unprofitable experience may be calculated taking into
6    account the refund period and the immediately preceding 2
7    plan years.
8    The Health Maintenance Organization shall include a
9statement in the evidence of coverage issued to each enrollee
10describing the possibility of a refund or additional premium,
11and upon request of any group or enrollment unit, provide to
12the group or enrollment unit a description of the method used
13to calculate (1) the Health Maintenance Organization's
14profitable experience with respect to the group or enrollment
15unit and the resulting refund to the group or enrollment unit
16or (2) the Health Maintenance Organization's unprofitable
17experience with respect to the group or enrollment unit and
18the resulting additional premium to be paid by the group or
19enrollment unit.
20    In no event shall the Illinois Health Maintenance
21Organization Guaranty Association be liable to pay any
22contractual obligation of an insolvent organization to pay any
23refund authorized under this Section.
24    (g) Rulemaking authority to implement Public Act 95-1045,
25if any, is conditioned on the rules being adopted in
26accordance with all provisions of the Illinois Administrative

 

 

SB2744 Engrossed- 14 -LRB103 35050 RPS 64995 b

1Procedure Act and all rules and procedures of the Joint
2Committee on Administrative Rules; any purported rule not so
3adopted, for whatever reason, is unauthorized.
4(Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
5102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
61-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
7eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
8102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
91-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
10eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
11103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
126-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
13eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.)
 
14    Section 35. The Voluntary Health Services Plans Act is
15amended by changing Section 10 as follows:
 
16    (215 ILCS 165/10)  (from Ch. 32, par. 604)
17    Sec. 10. Application of Insurance Code provisions. Health
18services plan corporations and all persons interested therein
19or dealing therewith shall be subject to the provisions of
20Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
21143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
22356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w,
23356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5,
24356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,

 

 

SB2744 Engrossed- 15 -LRB103 35050 RPS 64995 b

1356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
2356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
3356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
4356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64,
5356z.67, 356z.68, 356z.71, 364.01, 364.3, 367.2, 368a, 401,
6401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)
7and (15) of Section 367 of the Illinois Insurance Code.
8    Rulemaking authority to implement Public Act 95-1045, if
9any, is conditioned on the rules being adopted in accordance
10with all provisions of the Illinois Administrative Procedure
11Act and all rules and procedures of the Joint Committee on
12Administrative Rules; any purported rule not so adopted, for
13whatever reason, is unauthorized.
14(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
15102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
1610-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
17eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
18102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
191-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
20eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
21103-551, eff. 8-11-23; revised 8-29-23.)