103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
SB3972

 

Introduced 10/11/2024, by Sen. Willie Preston

 

SYNOPSIS AS INTRODUCED:
 
5 ILCS 375/6.11
55 ILCS 5/5-1069.3
65 ILCS 5/10-4-2.3
105 ILCS 5/10-22.3f
215 ILCS 5/356z.80 new
215 ILCS 125/5-3  from Ch. 111 1/2, par. 1411.2
215 ILCS 130/4003  from Ch. 73, par. 1504-3
215 ILCS 165/10  from Ch. 32, par. 604
305 ILCS 5/5-16.8
30 ILCS 805/8.48 new

    Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026 that provides coverage for: habilitative services shall provide coverage for habilitative speech therapy as a treatment for stuttering, regardless of whether the stuttering is classified as developmental; rehabilitative services shall provide coverage for rehabilitative speech therapy as a treatment for stuttering; or habilitative services and rehabilitative services shall provide coverage for habilitative speech therapy as a treatment for stuttering, regardless of whether the stuttering is classified as developmental, and shall provide coverage for rehabilitative speech therapy as a treatment for stuttering. Sets forth requirements and limitations for the coverage. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Illinois Public Aid Code to require coverage under those provisions. Amends the State Mandates Act to require implementation without reimbursement. Effective January 1, 2026.


LRB103 42708 RPS 75944 b

 

 

A BILL FOR

 

SB3972LRB103 42708 RPS 75944 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.80 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

 

 

SB3972- 2 -LRB103 42708 RPS 75944 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:
 

 

 

SB3972- 3 -LRB103 42708 RPS 75944 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.80 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

 

 

SB3972- 4 -LRB103 42708 RPS 75944 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,

 

 

SB3972- 5 -LRB103 42708 RPS 75944 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.80 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;

 

 

SB3972- 6 -LRB103 42708 RPS 75944 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.80 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.

 

 

SB3972- 7 -LRB103 42708 RPS 75944 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.80 as follows:
 
17    (215 ILCS 5/356z.80 new)
18    Sec. 356z.80. Coverage of treatment for stuttering.
19    (a) As used in this Section:
20    "Habilitative services" means health care services that
21help a person keep, learn, or improve skills and functioning
22for daily living.
23    "Habilitative speech therapy" means speech therapy that
24helps a person keep, learn, or improve skills and functioning

 

 

SB3972- 8 -LRB103 42708 RPS 75944 b

1for daily living.
2    "Rehabilitative services" means health care services that
3help a person restore or improve skills and functioning for
4daily living that have been lost or impaired.
5    "Rehabilitative speech therapy" means speech therapy that
6helps a person restore or improve skills and functioning for
7daily living that have been lost or impaired.
8    (b) Except as provided in subsection (d) of this Section,
9a group or individual policy of accident and health insurance
10or a managed care plan that is amended, delivered, issued, or
11renewed on or after January 1, 2026 that provides coverage
12for:
13        (1) habilitative services shall provide coverage for
14    habilitative speech therapy as a treatment for stuttering,
15    regardless of whether the stuttering is classified as
16    developmental;
17        (2) rehabilitative services shall provide coverage for
18    rehabilitative speech therapy as a treatment for
19    stuttering; or
20        (3) both habilitative services and rehabilitative
21    services shall provide the coverage required under
22    paragraphs (1) and (2) of this subsection.
23    (c) The coverage required under subsection (b) of this
24Section shall:
25        (1) not be:
26            (A) subject to any maximum annual benefit limit,

 

 

SB3972- 9 -LRB103 42708 RPS 75944 b

1        including any limits on the number of visits an
2        insured may make to a speech-language pathologist;
3            (B) limited based on the type of disease, injury,
4        disorder, or other medical condition that resulted in
5        the stuttering; or
6            (C) subject to utilization review or utilization
7        management requirements, including prior
8        authorization;
9        (2) be considered medically necessary if the patient's
10    treating provider determines, in his or her clinical
11    judgment, that such speech therapy services for stuttering
12    are medically appropriate to help the patient keep, learn,
13    improve, or restore skills or functioning for daily
14    living; and
15        (3) include coverage for speech therapy provided in
16    person and via telehealth, which shall:
17            (A) not be less than the coverage required for
18        health benefit plans under Section 356z.22; and
19            (B) include the use of any communication
20        technology, application, or platform to deliver
21        telehealth services, except coverage may be restricted
22        to technology, applications, or platforms that are
23        compliant with any applicable privacy provisions of
24        the federal Health Insurance Portability and
25        Accountability Act of 1996, 42 U.S.C. 1320d et seq.,
26        as amended.

 

 

SB3972- 10 -LRB103 42708 RPS 75944 b

1    (d) If, at any time, the Secretary of the United States
2Department of Health and Human Services, or its successor
3agency, promulgates rules or regulations to be published in
4the Federal Register or publishes a comment in the Federal
5Register or issues an opinion, guidance, or other action that
6would require the State, pursuant to any provision of the
7Patient Protection and Affordable Care Act (Public Law
8111-148), including, but not limited to, 42 U.S.C.
918031(d)(3)(B) or any successor provision, to defray the cost
10of any coverage outlined in this Section, then this Section is
11inoperative with respect to all coverage outlined in this
12Section other than that authorized under Section 1902 of the
13Social Security Act, 42 U.S.C. 1396a, and the State shall not
14assume any obligation for the cost of the coverage set forth in
15this Section.
 
16    Section 30. The Health Maintenance Organization Act is
17amended by changing Section 5-3 as follows:
 
18    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
19    Sec. 5-3. Insurance Code provisions.
20    (a) Health Maintenance Organizations shall be subject to
21the provisions of Sections 133, 134, 136, 137, 139, 140,
22141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
23154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49,
24355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356v,

 

 

SB3972- 11 -LRB103 42708 RPS 75944 b

1356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
2356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
3356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21, 356z.22,
4356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29, 356z.30,
5356z.30a, 356z.31, 356z.32, 356z.33, 356z.34, 356z.35,
6356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41, 356z.44,
7356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50, 356z.51,
8356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58, 356z.59,
9356z.60, 356z.61, 356z.62, 356z.64, 356z.65, 356z.67, 356z.68,
10356z.80, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b,
11368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A,
12408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
13subsection (2) of Section 367, and Articles IIA, VIII 1/2,
14XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
15Illinois 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

 

 

SB3972- 12 -LRB103 42708 RPS 75944 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

 

 

SB3972- 13 -LRB103 42708 RPS 75944 b

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.

 

 

SB3972- 14 -LRB103 42708 RPS 75944 b

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

 

 

SB3972- 15 -LRB103 42708 RPS 75944 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. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
26102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.

 

 

SB3972- 16 -LRB103 42708 RPS 75944 b

11-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
2eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
3102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
41-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
5eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
6103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
76-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
8eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.)
 
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, 155.49, 355.2,
17355.3, 355b, 356q, 356v, 356z.4, 356z.4a, 356z.10, 356z.21,
18356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32,
19356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
20356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 356z.80,
21364.3, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412,
22444, and 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,
23XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
24Nothing in this Section shall require a limited health care

 

 

SB3972- 17 -LRB103 42708 RPS 75944 b

1plan to cover any service that is not a limited health service.
2For purposes of the Illinois Insurance Code, except for
3Sections 444 and 444.1 and Articles XIII and XIII 1/2, limited
4health service organizations in the following categories are
5deemed to be domestic companies:
6        (1) a corporation under the laws of this State; or
7        (2) a corporation organized under the laws of another
8    state, 30% or more of the enrollees of which are residents
9    of this State, except a corporation subject to
10    substantially the same requirements in its state of
11    organization as is a domestic company under Article VIII
12    1/2 of the Illinois Insurance Code.
13(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
14102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
151-1-23; 102-775, eff. 5-13-22; 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; 103-84, eff. 1-1-24; 103-91, eff.
181-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
19eff. 1-1-24; revised 8-29-23.)
 
20    Section 40. The Voluntary Health Services Plans Act is
21amended by changing Section 10 as follows:
 
22    (215 ILCS 165/10)  (from Ch. 32, par. 604)
23    Sec. 10. Application of Insurance Code provisions. Health
24services plan corporations and all persons interested therein

 

 

SB3972- 18 -LRB103 42708 RPS 75944 b

1or dealing therewith shall be subject to the provisions of
2Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
3143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
4356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w,
5356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5,
6356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
7356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
8356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
9356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
10356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64,
11356z.67, 356z.68, 356z.80, 364.01, 364.3, 367.2, 368a, 401,
12401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)
13and (15) of Section 367 of the Illinois Insurance Code.
14    Rulemaking authority to implement Public Act 95-1045, if
15any, is conditioned on the rules being adopted in accordance
16with all provisions of the Illinois Administrative Procedure
17Act and all rules and procedures of the Joint Committee on
18Administrative Rules; any purported rule not so adopted, for
19whatever reason, is unauthorized.
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; 102-665, eff.
2210-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
23eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
24102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
251-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
26eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;

 

 

SB3972- 19 -LRB103 42708 RPS 75944 b

1103-551, eff. 8-11-23; revised 8-29-23.)
 
2    Section 45. The Illinois Public Aid Code is amended by
3changing Section 5-16.8 as follows:
 
4    (305 ILCS 5/5-16.8)
5    Sec. 5-16.8. Required health benefits. The medical
6assistance program shall (i) provide the post-mastectomy care
7benefits required to be covered by a policy of accident and
8health insurance under Section 356t and the coverage required
9under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
10356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
11356z.47, 356z.51, 356z.53, 356z.56, 356z.59, 356z.60, and
12356z.61, 356z.64, 356z.67, and 356z.80 of the Illinois
13Insurance Code, (ii) be subject to the provisions of Sections
14356z.19, 356z.44, 356z.49, 364.01, 370c, and 370c.1 of the
15Illinois Insurance Code, and (iii) be subject to the
16provisions of subsection (d-5) of Section 10 of the Network
17Adequacy and Transparency Act.
18    The Department, by rule, shall adopt a model similar to
19the requirements of Section 356z.39 of the Illinois Insurance
20Code.
21    On and after July 1, 2012, the Department shall reduce any
22rate of reimbursement for services or other payments or alter
23any methodologies authorized by this Code to reduce any rate
24of reimbursement for services or other payments in accordance

 

 

SB3972- 20 -LRB103 42708 RPS 75944 b

1with Section 5-5e.
2    To ensure full access to the benefits set forth in this
3Section, on and after January 1, 2016, the Department shall
4ensure that provider and hospital reimbursement for
5post-mastectomy care benefits required under this Section are
6no lower than the Medicare reimbursement rate.
7(Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22;
8102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff.
91-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813,
10eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23;
11102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
121-1-24; 103-420, eff. 1-1-24; revised 12-15-23.)
 
13    Section 90. The State Mandates Act is amended by adding
14Section 8.48 as follows:
 
15    (30 ILCS 805/8.48 new)
16    Sec. 8.48. Exempt mandate. Notwithstanding Sections 6 and
178 of this Act, no reimbursement by the State is required for
18the implementation of any mandate created by this amendatory
19Act of the 103rd General Assembly.
 
20    Section 99. Effective date. This Act takes effect January
211, 2026.