SB0773enr 103RD GENERAL ASSEMBLY

 


 
SB0773 EnrolledLRB103 03229 AMQ 48235 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 Sections 6.11 and 6.11B 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

 

 

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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    (5 ILCS 375/6.11B)
25    Sec. 6.11B. Infertility coverage.

 

 

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1    (a) Beginning on January 1, 2024, the State Employees
2Group Insurance Program shall provide coverage for the
3diagnosis and treatment of infertility, including, but not
4limited to, in vitro fertilization, uterine embryo lavage,
5embryo transfer, artificial insemination, gamete
6intrafallopian tube transfer, zygote intrafallopian tube
7transfer, and low tubal ovum transfer. The coverage required
8shall include procedures necessary to screen or diagnose a
9fertilized egg before implantation, including, but not limited
10to, preimplantation genetic diagnosis, preimplantation genetic
11screening, and prenatal genetic diagnosis.
12    (b) Beginning on January 1, 2024, coverage under this
13Section for procedures for in vitro fertilization, gamete
14intrafallopian tube transfer, or zygote intrafallopian tube
15transfer shall be required only if the procedures:
16        (1) are considered medically appropriate based on
17    clinical guidelines or standards developed by the American
18    Society for Reproductive Medicine, the American College of
19    Obstetricians and Gynecologists, or the Society for
20    Assisted Reproductive Technology; and
21        (2) are performed at medical facilities or clinics
22    that conform to the American College of Obstetricians and
23    Gynecologists guidelines for in vitro fertilization or the
24    American Society for Reproductive Medicine minimum
25    standards for practices offering assisted reproductive
26    technologies.

 

 

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1    (c) As used in this Section, "infertility" means a
2disease, condition, or status characterized by:
3        (1) a failure to establish a pregnancy or to carry a
4    pregnancy to live birth after 12 months of regular,
5    unprotected sexual intercourse if the woman is 35 years of
6    age or younger, or after 6 months of regular, unprotected
7    sexual intercourse if the woman is over 35 years of age;
8    conceiving but having a miscarriage does not restart the
9    12-month or 6-month term for determining infertility;
10        (2) a person's inability to reproduce either as a
11    single individual or with a partner without medical
12    intervention; or
13        (3) a licensed physician's findings based on a
14    patient's medical, sexual, and reproductive history, age,
15    physical findings, or diagnostic testing.
16    (d) The State Employees Group Insurance Program may not
17impose any exclusions, limitations, or other restrictions on
18coverage of fertility medications that are different from
19those imposed on any other prescription medications, nor may
20it impose any exclusions, limitations, or other restrictions
21on coverage of any fertility services based on a covered
22individual's participation in fertility services provided by
23or to a third party, nor may it impose deductibles,
24copayments, coinsurance, benefit maximums, waiting periods, or
25any other limitations on coverage for the diagnosis of
26infertility, treatment for infertility, and standard fertility

 

 

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1preservation services, except as provided in this Section,
2that are different from those imposed upon benefits for
3services not related to infertility.
4    (e) This Section applies only to coverage provided on or
5after January 1, 2024 and before July 1, 2026.
6    (f) This Section is repealed on July 1, 2026.
7(Source: P.A. 103-8, eff. 1-1-24.)
 
8    Section 10. The Counties Code is amended by changing
9Section 5-1069.3 as follows:
 
10    (55 ILCS 5/5-1069.3)
11    Sec. 5-1069.3. Required health benefits. If a county,
12including a home rule county, is a self-insurer for purposes
13of providing health insurance coverage for its employees, the
14coverage shall include coverage for the post-mastectomy care
15benefits required to be covered by a policy of accident and
16health insurance under Section 356t and the coverage required
17under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w,
18356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
19356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25,
20356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36,
21356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
22356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and
23356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, 356z.70, and
24356z.71 of the Illinois Insurance Code. The coverage shall

 

 

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1comply with Sections 155.22a, 355b, 356z.19, and 370c of the
2Illinois Insurance Code. The Department of Insurance shall
3enforce the requirements of this Section. The requirement that
4health benefits be covered as provided in this Section is an
5exclusive power and function of the State and is a denial and
6limitation under Article VII, Section 6, subsection (h) of the
7Illinois Constitution. A home rule county to which this
8Section applies must comply with every provision of this
9Section.
10    Rulemaking authority to implement Public Act 95-1045, if
11any, is conditioned on the rules being adopted in accordance
12with all provisions of the Illinois Administrative Procedure
13Act and all rules and procedures of the Joint Committee on
14Administrative Rules; any purported rule not so adopted, for
15whatever reason, is unauthorized.
16(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
17102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
181-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
19eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
20102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
211-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
22eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
23103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
248-29-23.)
 
25    Section 15. The Illinois Municipal Code is amended by

 

 

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1changing Section 10-4-2.3 as follows:
 
2    (65 ILCS 5/10-4-2.3)
3    Sec. 10-4-2.3. Required health benefits. If a
4municipality, including a home rule municipality, is a
5self-insurer for purposes of providing health insurance
6coverage for its employees, the coverage shall include
7coverage for the post-mastectomy care benefits required to be
8covered by a policy of accident and health insurance under
9Section 356t and the coverage required under Sections 356g,
10356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x, 356z.4,
11356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
12356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
13356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
14356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
15356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and 356z.62,
16356z.64, 356z.67, 356z.68, 356z.70, and 356z.71 of the
17Illinois Insurance Code. The coverage shall comply with
18Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
19Insurance Code. The Department of Insurance shall enforce the
20requirements of this Section. The requirement that health
21benefits be covered as provided in this is an exclusive power
22and function of the State and is a denial and limitation under
23Article VII, Section 6, subsection (h) of the Illinois
24Constitution. A home rule municipality to which this Section
25applies must comply with every provision of this Section.

 

 

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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; 102-443, eff.
91-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
10eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
11102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
121-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
13eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
14103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
158-29-23.)
 
16    Section 20. The School Code is amended by changing Section
1710-22.3f as follows:
 
18    (105 ILCS 5/10-22.3f)
19    Sec. 10-22.3f. Required health benefits. Insurance
20protection and benefits for employees shall provide the
21post-mastectomy care benefits required to be covered by a
22policy of accident and health insurance under Section 356t and
23the coverage required under Sections 356g, 356g.5, 356g.5-1,
24356m, 356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8,

 

 

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1356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
2356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
3356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
4356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and
5356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, 356z.70, and
6356z.71 of the Illinois Insurance Code. Insurance policies
7shall comply with Section 356z.19 of the Illinois Insurance
8Code. The coverage shall comply with Sections 155.22a, 355b,
9and 370c of the Illinois Insurance Code. The Department of
10Insurance shall enforce the requirements of this Section.
11    Rulemaking authority to implement Public Act 95-1045, if
12any, is conditioned on the rules being adopted in accordance
13with all provisions of the Illinois Administrative Procedure
14Act and all rules and procedures of the Joint Committee on
15Administrative Rules; any purported rule not so adopted, for
16whatever reason, is unauthorized.
17(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
18102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
191-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,
20eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
21102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.
221-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,
23eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;
24103-551, eff. 8-11-23; revised 8-29-23.)
 
25    Section 25. The Illinois Insurance Code is amended by

 

 

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1changing Sections 356m and 356z.32 and by adding Section
2356z.71 as follows:
 
3    (215 ILCS 5/356m)  (from Ch. 73, par. 968m)
4    Sec. 356m. Infertility coverage.
5    (a) No group policy of accident and health insurance
6providing coverage for more than 25 employees that provides
7pregnancy-related pregnancy related benefits may be issued,
8amended, delivered, or renewed in this State after January 1,
92016 and through December 31, 2025 the effective date of this
10amendatory Act of the 99th General Assembly unless the policy
11contains coverage for the diagnosis and treatment of
12infertility including, but not limited to, in vitro
13fertilization, uterine embryo lavage, embryo transfer,
14artificial insemination, gamete intrafallopian tube transfer,
15zygote intrafallopian tube transfer, and low tubal ovum
16transfer.
17    (a-5) No group policy of accident and health insurance
18that provides pregnancy-related benefits may be issued,
19amended, delivered, or renewed in this State on or after
20January 1, 2026 unless the policy contains coverage for the
21diagnosis and treatment of infertility, including, but not
22limited to, in vitro fertilization, uterine embryo lavage,
23embryo transfer, artificial insemination, gamete
24intrafallopian tube transfer, zygote intrafallopian tube
25transfer, surgical sperm extraction procedures, and low tubal

 

 

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1ovum transfer. The coverage required shall include procedures
2necessary to screen or diagnose a fertilized egg before
3implantation, including, but not limited to, preimplantation
4genetic testing for aneuploidy, preimplantation genetic
5testing for chromosome structural rearrangements, and
6preimplantation genetic testing for monogenic or single gene
7disorders. Coverage under this subsection for the diagnosis
8and treatment of infertility shall be required only if the
9procedures:
10        (1) are considered medically appropriate by the
11    patient's medical provider based on clinical guidelines or
12    standards developed by the American Society for
13    Reproductive Medicine, the American College of
14    Obstetricians and Gynecologists, or the Society for
15    Assisted Reproductive Technology; and
16        (2) are performed at medical facilities or clinics
17    that are members in good standing of the Society for
18    Assisted Reproductive Technology.
19    (b) The coverage required under subsection (a) for
20procedures for in vitro fertilization, gamete intrafallopian
21tube transfer, or zygote intrafallopian tube transfer shall be
22required only if is subject to the following conditions:
23        (1) Coverage for procedures for in vitro
24    fertilization, gamete intrafallopian tube transfer, or
25    zygote intrafallopian tube transfer shall be required only
26    if:

 

 

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1        (1) (A) the covered individual has been unable to
2    attain a viable pregnancy, maintain a viable pregnancy, or
3    sustain a successful pregnancy through reasonable, less
4    costly medically appropriate infertility treatments for
5    which coverage is available under the policy, plan, or
6    contract;
7        (2) (B) the covered individual has not undergone 4
8    completed oocyte retrievals, except that if a live birth
9    follows a completed oocyte retrieval, then 2 more
10    completed oocyte retrievals shall be covered; and
11        (3) (C) the procedures are performed at medical
12    facilities that conform to the American College of
13    Obstetric and Gynecology guidelines for in vitro
14    fertilization clinics or to the American Fertility Society
15    minimal standards for programs of in vitro fertilization.
16        (2) The procedures required to be covered under this
17    Section are not required to be contained in any policy or
18    plan issued to or by a religious institution or
19    organization or to or by an entity sponsored by a
20    religious institution or organization that finds the
21    procedures required to be covered under this Section to
22    violate its religious and moral teachings and beliefs.
23    (c) As used in this Section, "infertility" means a
24disease, condition, or status characterized by:
25        (1) a failure to establish a pregnancy or to carry a
26    pregnancy to live birth after 12 months of regular,

 

 

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1    unprotected sexual intercourse if the woman is 35 years of
2    age or younger, or after 6 months of regular, unprotected
3    sexual intercourse if the woman is over 35 years of age;
4    conceiving but having a miscarriage does not restart the
5    12-month or 6-month term for determining infertility;
6        (2) a person's inability to reproduce either as a
7    single individual or with a partner without medical
8    intervention; or
9        (3) a licensed physician's findings based on a
10    patient's medical, sexual, and reproductive history, age,
11    physical findings, or diagnostic testing.
12    (d) A policy, contract, or certificate may not impose any
13exclusions, limitations, or other restrictions on coverage of
14fertility medications that are different from those imposed on
15any other prescription medications, nor may it impose any
16exclusions, limitations, or other restrictions on coverage of
17any fertility services based on a covered individual's
18participation in fertility services provided by or to a third
19party, nor may it impose deductibles, copayments, coinsurance,
20benefit maximums, waiting periods, or any other limitations on
21coverage for the diagnosis of infertility, treatment for
22infertility, and standard fertility preservation services,
23except as provided in this Section, that are different from
24those imposed upon benefits for services not related to
25infertility.
26    (e) The procedures required to be covered under this

 

 

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1Section are not required to be contained in any policy or plan
2issued to or by a religious institution or organization or to
3or by an entity sponsored by a religious institution or
4organization that finds the procedures required to be covered
5under this Section to violate its religious and moral
6teachings and beliefs.
7(Source: P.A. 102-170, eff. 1-1-22.)
 
8    (215 ILCS 5/356z.71 new)
9    Sec. 356z.71. Coverage for annual menopause health visit.
10A group or individual policy of accident and health insurance
11providing coverage for more than 25 employees that is amended,
12delivered, issued, or renewed on or after January 1, 2026
13shall provide, for individuals 45 years of age and older,
14coverage for an annual menopause health visit. A policy
15subject to this Section shall not impose a deductible,
16coinsurance, copayment, or any other cost-sharing requirement
17on the coverage provided; except that this Section does not
18apply to this coverage to the extent such coverage would
19disqualify a high-deductible health plan from eligibility for
20a health savings account pursuant to Section 223 of the
21Internal Revenue Code.
 
22    Section 30. The Health Maintenance Organization Act is
23amended by changing Section 5-3 as follows:
 

 

 

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1    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
2    Sec. 5-3. Insurance Code provisions.
3    (a) Health Maintenance Organizations shall be subject to
4the provisions of Sections 133, 134, 136, 137, 139, 140,
5141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
6154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49,
7355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356v,
8356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
9356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
10356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21, 356z.22,
11356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29, 356z.30,
12356z.30a, 356z.31, 356z.32, 356z.33, 356z.34, 356z.35,
13356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41, 356z.44,
14356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50, 356z.51,
15356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58, 356z.59,
16356z.60, 356z.61, 356z.62, 356z.64, 356z.65, 356z.67, 356z.68,
17356z.71, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b,
18368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A,
19408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
20subsection (2) of Section 367, and Articles IIA, VIII 1/2,
21XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
22Illinois Insurance Code.
23    (b) For purposes of the Illinois Insurance Code, except
24for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
25Health Maintenance Organizations in the following categories
26are deemed to be "domestic companies":

 

 

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

 

 

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

 

 

SB0773 Enrolled- 18 -LRB103 03229 AMQ 48235 b

1specified in Section 141.2 of the Illinois Insurance Code,
2take into account the effect of the management contract or
3service agreement on the continuation of benefits to enrollees
4and the financial condition of the health maintenance
5organization to be managed or serviced, and (ii) need not take
6into account the effect of the management contract or service
7agreement on competition.
8    (f) Except for small employer groups as defined in the
9Small Employer Rating, Renewability and Portability Health
10Insurance Act and except for medicare supplement policies as
11defined in Section 363 of the Illinois Insurance Code, a
12Health Maintenance Organization may by contract agree with a
13group or other enrollment unit to effect refunds or charge
14additional premiums under the following terms and conditions:
15        (i) the amount of, and other terms and conditions with
16    respect to, the refund or additional premium are set forth
17    in the group or enrollment unit contract agreed in advance
18    of the period for which a refund is to be paid or
19    additional premium is to be charged (which period shall
20    not be less than one year); and
21        (ii) the amount of the refund or additional premium
22    shall not exceed 20% of the Health Maintenance
23    Organization's profitable or unprofitable experience with
24    respect to the group or other enrollment unit for the
25    period (and, for purposes of a refund or additional
26    premium, the profitable or unprofitable experience shall

 

 

SB0773 Enrolled- 19 -LRB103 03229 AMQ 48235 b

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

 

 

SB0773 Enrolled- 20 -LRB103 03229 AMQ 48235 b

1if any, is conditioned on the rules being adopted in
2accordance with all provisions of the Illinois Administrative
3Procedure Act and all rules and procedures of the Joint
4Committee on Administrative Rules; any purported rule not so
5adopted, for whatever reason, is unauthorized.
6(Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
7102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
81-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
9eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
10102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
111-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
12eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
13103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
146-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
15eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.)
 
16    Section 35. The Limited Health Service Organization Act is
17amended by changing Section 4003 as follows:
 
18    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
19    Sec. 4003. Illinois Insurance Code provisions. Limited
20health service organizations shall be subject to the
21provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
22141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
23154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 355.2,
24355.3, 355b, 356m, 356q, 356v, 356z.4, 356z.4a, 356z.10,

 

 

SB0773 Enrolled- 21 -LRB103 03229 AMQ 48235 b

1356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30a,
2356z.32, 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53,
3356z.54, 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68,
4356z.71, 364.3, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2,
5409, 412, 444, and 444.1 and Articles IIA, VIII 1/2, XII, XII
61/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois Insurance
7Code. Nothing in this Section shall require a limited health
8care plan to cover any service that is not a limited health
9service. For purposes of the Illinois Insurance Code, except
10for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
11limited health service organizations in the following
12categories are deemed to be domestic companies:
13        (1) a corporation under the laws of this State; or
14        (2) a corporation organized under the laws of another
15    state, 30% or more of the enrollees of which are residents
16    of this State, except a corporation subject to
17    substantially the same requirements in its state of
18    organization as is a domestic company under Article VIII
19    1/2 of the Illinois Insurance Code.
20(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
21102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
221-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,
23eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
24102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
251-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
26eff. 1-1-24; revised 8-29-23.)
 

 

 

SB0773 Enrolled- 22 -LRB103 03229 AMQ 48235 b

1    Section 40. The Voluntary Health Services Plans Act is
2amended by changing Section 10 as follows:
 
3    (215 ILCS 165/10)  (from Ch. 32, par. 604)
4    Sec. 10. Application of Insurance Code provisions. Health
5services plan corporations and all persons interested therein
6or dealing therewith shall be subject to the provisions of
7Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
8143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
9356g, 356g.5, 356g.5-1, 356m, 356q, 356r, 356t, 356u, 356v,
10356w, 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a,
11356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
12356z.13, 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22,
13356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32,
14356z.32a, 356z.33, 356z.40, 356z.41, 356z.46, 356z.47,
15356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60,
16356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.71, 364.01,
17364.3, 367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2,
18and 412, and paragraphs (7) and (15) of Section 367 of the
19Illinois Insurance Code.
20    Rulemaking authority to implement Public Act 95-1045, if
21any, is conditioned on the rules being adopted in accordance
22with all provisions of the Illinois Administrative Procedure
23Act and all rules and procedures of the Joint Committee on
24Administrative Rules; any purported rule not so adopted, for

 

 

SB0773 Enrolled- 23 -LRB103 03229 AMQ 48235 b

1whatever reason, is unauthorized.
2(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
3102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
410-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
5eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
6102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
71-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
8eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
9103-551, eff. 8-11-23; revised 8-29-23.)
 
10    Section 99. Effective date. This Act takes effect upon
11becoming law.