103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
HB5493

 

Introduced 2/9/2024, by Rep. Thaddeus Jones

 

SYNOPSIS AS INTRODUCED:
 
See Index

    Amends the Illinois Insurance Code. Provides that certain coverage requirements apply to an individual policy of accident and health insurance (currently, a policy of accident and health insurance). Provides that an individual or group policy of accident and health insurance or a managed care plan must not require authorization or referral by the plan, issuer, or any person, including a primary care provider, for any covered individual who seeks coverage for certain obstetrical or gynecological care. Provides that if a policy, contract, or certificate requires or allows a covered individual to designate a primary care provider and provides coverage for any obstetrical or gynecological care, the insurer shall provide the notice required under specified federal regulations in all circumstances required under those regulations. Makes changes in provisions concerning post-parturition care. Changes the language required in the disclosure of a limited benefit. Increases the fee for filing a plan of division of a domestic stock company and for filing an insurance business transfer plan. Makes changes in provisions concerning fraud reporting; coverage for epinephrine injectors; blanket accident and health insurance; authorization of policies, agreements, or arrangements with incentives or limits on reimbursement; and refunds and penalties. Repeals a provision concerning the application of certain provisions. Amends the Network Adequacy and Transparency Act. Changes references from "woman's principal health care provider" to "obstetrical and gynecological health care professional". Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Limited Health Service Organization Act, and the Illinois Public Aid Code to make conforming changes. Amends the Health Maintenance Organization Act. Makes changes to the required disclosures. Provides that health maintenance organizations are subject to certain coverage requirements for pharmacy testing, screening, vaccinations, and treatment; for proton beam therapy; for children with neuromuscular, neurological, or cognitive impairment; and for no-cost mental health prevention and wellness visits. Effective immediately, except that certain provisions are effective January 1, 2025.


LRB103 39189 RPS 69335 b

 

 

A BILL FOR

 

HB5493LRB103 39189 RPS 69335 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 6.7 as follows:
 
6    (5 ILCS 375/6.7)
7    Sec. 6.7. Access to obstetrical and gynecological care
8Woman's health care provider. The program of health benefits
9is subject to the provisions of Section 356r of the Illinois
10Insurance Code.
11(Source: P.A. 89-514, eff. 7-17-96; 90-14, eff. 7-1-97.)
 
12    Section 10. The Counties Code is amended by changing
13Section 5-1069.5 as follows:
 
14    (55 ILCS 5/5-1069.5)
15    Sec. 5-1069.5. Access to obstetrical and gynecological
16care Woman's health care provider. All counties, including
17home rule counties, are subject to the provisions of Section
18356r of the Illinois Insurance Code. The requirement under
19this Section that health care benefits provided by counties
20comply with Section 356r of the Illinois Insurance Code is an
21exclusive power and function of the State and is a denial and

 

 

HB5493- 2 -LRB103 39189 RPS 69335 b

1limitation of home rule county powers under Article VII,
2Section 6, subsection (h) of the Illinois Constitution.
3(Source: P.A. 89-514, eff. 7-17-96; 90-14, eff. 7-1-97.)
 
4    Section 15. The Illinois Municipal Code is amended by
5changing Section 10-4-2.5 as follows:
 
6    (65 ILCS 5/10-4-2.5)
7    Sec. 10-4-2.5. Access to obstetrical and gynecological
8care Woman's health care provider. The corporate authorities
9of all municipalities are subject to the provisions of Section
10356r of the Illinois Insurance Code. The requirement under
11this Section that health care benefits provided by
12municipalities comply with Section 356r of the Illinois
13Insurance Code is an exclusive power and function of the State
14and is a denial and limitation of home rule municipality
15powers under Article VII, Section 6, subsection (h) of the
16Illinois Constitution.
17(Source: P.A. 89-514, eff. 7-17-96; 90-14, eff. 7-1-97.)
 
18    Section 20. The School Code is amended by changing Section
1910-22.3d as follows:
 
20    (105 ILCS 5/10-22.3d)
21    Sec. 10-22.3d. Access to obstetrical and gynecological
22care Woman's health care provider. Insurance protection and

 

 

HB5493- 3 -LRB103 39189 RPS 69335 b

1benefits for employees are subject to the provisions of
2Section 356r of the Illinois Insurance Code.
3(Source: P.A. 89-514, eff. 7-17-96; 90-14, eff. 7-1-97.)
 
4    Section 25. The Illinois Insurance Code is amended by
5changing Sections 4, 155.23, 352, 352b, 356a, 356b, 356d,
6356e, 356f, 356K, 356L, 356r, 356s, 356z.3, 356z.33, 367a,
7370e, 370i, 408, 412, and 531.03 as follows:
 
8    (215 ILCS 5/4)  (from Ch. 73, par. 616)
9    Sec. 4. Classes of insurance. Insurance and insurance
10business shall be classified as follows:
11    Class 1. Life, Accident and Health.
12    (a) Life. Insurance on the lives of persons and every
13insurance appertaining thereto or connected therewith and
14granting, purchasing or disposing of annuities. Policies of
15life or endowment insurance or annuity contracts or contracts
16supplemental thereto which contain provisions for additional
17benefits in case of death by accidental means and provisions
18operating to safeguard such policies or contracts against
19lapse, to give a special surrender value, or special benefit,
20or an annuity, in the event, that the insured or annuitant
21shall become a person with a total and permanent disability as
22defined by the policy or contract, or which contain benefits
23providing acceleration of life or endowment or annuity
24benefits in advance of the time they would otherwise be

 

 

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1payable, as an indemnity for long term care which is certified
2or ordered by a physician, including but not limited to,
3professional nursing care, medical care expenses, custodial
4nursing care, non-nursing custodial care provided in a nursing
5home or at a residence of the insured, or which contain
6benefits providing acceleration of life or endowment or
7annuity benefits in advance of the time they would otherwise
8be payable, at any time during the insured's lifetime, as an
9indemnity for a terminal illness shall be deemed to be
10policies of life or endowment insurance or annuity contracts
11within the intent of this clause.
12    Also to be deemed as policies of life or endowment
13insurance or annuity contracts within the intent of this
14clause shall be those policies or riders that provide for the
15payment of up to 75% of the face amount of benefits in advance
16of the time they would otherwise be payable upon a diagnosis by
17a physician licensed to practice medicine in all of its
18branches that the insured has incurred a covered condition
19listed in the policy or rider.
20    "Covered condition", as used in this clause, means: heart
21attack, stroke, coronary artery surgery, life-threatening life
22threatening cancer, renal failure, Alzheimer's disease,
23paraplegia, major organ transplantation, total and permanent
24disability, and any other medical condition that the
25Department may approve for any particular filing.
26    The Director may issue rules that specify prohibited

 

 

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1policy provisions, not otherwise specifically prohibited by
2law, which in the opinion of the Director are unjust, unfair,
3or unfairly discriminatory to the policyholder, any person
4insured under the policy, or beneficiary.
5    (b) Accident and health. Insurance against bodily injury,
6disablement or death by accident and against disablement
7resulting from sickness or old age and every insurance
8appertaining thereto, including stop-loss insurance. In this
9clause, "stop-loss Stop-loss insurance" means is insurance
10against the risk of economic loss issued to or for the benefit
11of a single employer self-funded employee disability benefit
12plan or an employee welfare benefit plan as described in 29
13U.S.C. 1001 100 et seq., where (i) the policy is issued to and
14insures an employer, trustee, or other sponsor of the plan, or
15the plan itself, but not employees, members, or participants;
16and (ii) payments by the insurer are made to the employer,
17trustee, or other sponsors of the plan, or the plan itself, but
18not to the employees, members, participants, or health care
19providers. The insurance laws of this State, including this
20Code, do not apply to arrangements between a religious
21organization and the organization's members or participants
22when the arrangement and organization meet all of the
23following criteria:
24        (i) the organization is described in Section 501(c)(3)
25    of the Internal Revenue Code and is exempt from taxation
26    under Section 501(a) of the Internal Revenue Code;

 

 

HB5493- 6 -LRB103 39189 RPS 69335 b

1        (ii) members of the organization share a common set of
2    ethical or religious beliefs and share medical expenses
3    among members in accordance with those beliefs and without
4    regard to the state in which a member resides or is
5    employed;
6        (iii) no funds that have been given for the purpose of
7    the sharing of medical expenses among members described in
8    paragraph (ii) of this subsection (b) are held by the
9    organization in an off-shore trust or bank account;
10        (iv) the organization provides at least monthly to all
11    of its members a written statement listing the dollar
12    amount of qualified medical expenses that members have
13    submitted for sharing, as well as the amount of expenses
14    actually shared among the members;
15        (v) members of the organization retain membership even
16    after they develop a medical condition;
17        (vi) the organization or a predecessor organization
18    has been in existence at all times since December 31,
19    1999, and medical expenses of its members have been shared
20    continuously and without interruption since at least
21    December 31, 1999;
22        (vii) the organization conducts an annual audit that
23    is performed by an independent certified public accounting
24    firm in accordance with generally accepted accounting
25    principles and is made available to the public upon
26    request;

 

 

HB5493- 7 -LRB103 39189 RPS 69335 b

1        (viii) the organization includes the following
2    statement, in writing, on or accompanying all applications
3    and guideline materials:
4        "Notice: The organization facilitating the sharing of
5        medical expenses is not an insurance company, and
6        neither its guidelines nor plan of operation
7        constitute or create an insurance policy. Any
8        assistance you receive with your medical bills will be
9        totally voluntary. As such, participation in the
10        organization or a subscription to any of its documents
11        should never be considered to be insurance. Whether or
12        not you receive any payments for medical expenses and
13        whether or not this organization continues to operate,
14        you are always personally responsible for the payment
15        of your own medical bills.";
16        (ix) any membership card or similar document issued by
17    the organization and any written communication sent by the
18    organization to a hospital, physician, or other health
19    care provider shall include a statement that the
20    organization does not issue health insurance and that the
21    member or participant is personally liable for payment of
22    his or her medical bills;
23        (x) the organization provides to a participant, within
24    30 days after the participant joins, a complete set of its
25    rules for the sharing of medical expenses, appeals of
26    decisions made by the organization, and the filing of

 

 

HB5493- 8 -LRB103 39189 RPS 69335 b

1    complaints;
2        (xi) the organization does not offer any other
3    services that are regulated under any provision of the
4    Illinois Insurance Code or other insurance laws of this
5    State; and
6        (xii) the organization does not amass funds as
7    reserves intended for payment of medical services, rather
8    the organization facilitates the payments provided for in
9    this subsection (b) through payments made directly from
10    one participant to another.
11    (c) Legal Expense Insurance. Insurance which involves the
12assumption of a contractual obligation to reimburse the
13beneficiary against or pay on behalf of the beneficiary, all
14or a portion of his fees, costs, or expenses related to or
15arising out of services performed by or under the supervision
16of an attorney licensed to practice in the jurisdiction
17wherein the services are performed, regardless of whether the
18payment is made by the beneficiaries individually or by a
19third person for them, but does not include the provision of or
20reimbursement for legal services incidental to other insurance
21coverages. The insurance laws of this State, including this
22Act do not apply to:
23        (i) retainer contracts made by attorneys at law with
24    individual clients with fees based on estimates of the
25    nature and amount of services to be provided to the
26    specific client, and similar contracts made with a group

 

 

HB5493- 9 -LRB103 39189 RPS 69335 b

1    of clients involved in the same or closely related legal
2    matters;
3        (ii) plans owned or operated by attorneys who are the
4    providers of legal services to the plan;
5        (iii) plans providing legal service benefits to groups
6    where such plans are owned or operated by authority of a
7    state, county, local or other bar association;
8        (iv) any lawyer referral service authorized or
9    operated by a state, county, local or other bar
10    association;
11        (v) the furnishing of legal assistance by labor unions
12    and other employee organizations to their members in
13    matters relating to employment or occupation;
14        (vi) the furnishing of legal assistance to members or
15    dependents, by churches, consumer organizations,
16    cooperatives, educational institutions, credit unions, or
17    organizations of employees, where such organizations
18    contract directly with lawyers or law firms for the
19    provision of legal services, and the administration and
20    marketing of such legal services is wholly conducted by
21    the organization or its subsidiary;
22        (vii) legal services provided by an employee welfare
23    benefit plan defined by the Employee Retirement Income
24    Security Act of 1974;
25        (viii) any collectively bargained plan for legal
26    services between a labor union and an employer negotiated

 

 

HB5493- 10 -LRB103 39189 RPS 69335 b

1    pursuant to Section 302 of the Labor Management Relations
2    Act as now or hereafter amended, under which plan legal
3    services will be provided for employees of the employer
4    whether or not payments for such services are funded to or
5    through an insurance company.
6    Class 2. Casualty, Fidelity and Surety.
7    (a) Accident and health. Insurance against bodily injury,
8disablement or death by accident and against disablement
9resulting from sickness or old age and every insurance
10appertaining thereto, including stop-loss insurance. In this
11clause, "stop-loss Stop-loss insurance" has meaning given to
12that term in clause (b) of Class 1 is insurance against the
13risk of economic loss issued to a single employer self-funded
14employee disability benefit plan or an employee welfare
15benefit plan as described in 29 U.S.C. 1001 et seq.
16    (b) Vehicle. Insurance against any loss or liability
17resulting from or incident to the ownership, maintenance or
18use of any vehicle (motor or otherwise), draft animal or
19aircraft. Any policy insuring against any loss or liability on
20account of the bodily injury or death of any person may contain
21a provision for payment of disability benefits to injured
22persons and death benefits to dependents, beneficiaries or
23personal representatives of persons who are killed, including
24the named insured, irrespective of legal liability of the
25insured, if the injury or death for which benefits are
26provided is caused by accident and sustained while in or upon

 

 

HB5493- 11 -LRB103 39189 RPS 69335 b

1or while entering into or alighting from or through being
2struck by a vehicle (motor or otherwise), draft animal or
3aircraft, and such provision shall not be deemed to be
4accident insurance.
5    (c) Liability. Insurance against the liability of the
6insured for the death, injury or disability of an employee or
7other person, and insurance against the liability of the
8insured for damage to or destruction of another person's
9property.
10    (d) Workers' compensation. Insurance of the obligations
11accepted by or imposed upon employers under laws for workers'
12compensation.
13    (e) Burglary and forgery. Insurance against loss or damage
14by burglary, theft, larceny, robbery, forgery, fraud or
15otherwise; including all householders' personal property
16floater risks.
17    (f) Glass. Insurance against loss or damage to glass
18including lettering, ornamentation and fittings from any
19cause.
20    (g) Fidelity and surety. Become surety or guarantor for
21any person, copartnership or corporation in any position or
22place of trust or as custodian of money or property, public or
23private; or, becoming a surety or guarantor for the
24performance of any person, copartnership or corporation of any
25lawful obligation, undertaking, agreement or contract of any
26kind, except contracts or policies of insurance; and

 

 

HB5493- 12 -LRB103 39189 RPS 69335 b

1underwriting blanket bonds. Such obligations shall be known
2and treated as suretyship obligations and such business shall
3be known as surety business.
4    (h) Miscellaneous. Insurance against loss or damage to
5property and any liability of the insured caused by accidents
6to boilers, pipes, pressure containers, machinery and
7apparatus of any kind and any apparatus connected thereto, or
8used for creating, transmitting or applying power, light,
9heat, steam or refrigeration, making inspection of and issuing
10certificates of inspection upon elevators, boilers, machinery
11and apparatus of any kind and all mechanical apparatus and
12appliances appertaining thereto; insurance against loss or
13damage by water entering through leaks or openings in
14buildings, or from the breakage or leakage of a sprinkler,
15pumps, water pipes, plumbing and all tanks, apparatus,
16conduits and containers designed to bring water into buildings
17or for its storage or utilization therein, or caused by the
18falling of a tank, tank platform or supports, or against loss
19or damage from any cause (other than causes specifically
20enumerated under Class 3 of this Section) to such sprinkler,
21pumps, water pipes, plumbing, tanks, apparatus, conduits or
22containers; insurance against loss or damage which may result
23from the failure of debtors to pay their obligations to the
24insured; and insurance of the payment of money for personal
25services under contracts of hiring.
26    (i) Other casualty risks. Insurance against any other

 

 

HB5493- 13 -LRB103 39189 RPS 69335 b

1casualty risk not otherwise specified under Classes 1 or 3,
2which may lawfully be the subject of insurance and may
3properly be classified under Class 2.
4    (j) Contingent losses. Contingent, consequential and
5indirect coverages wherein the proximate cause of the loss is
6attributable to any one of the causes enumerated under Class
72. Such coverages shall, for the purpose of classification, be
8included in the specific grouping of the kinds of insurance
9wherein such cause is specified.
10    (k) Livestock and domestic animals. Insurance against
11mortality, accident and health of livestock and domestic
12animals.
13    (l) Legal expense insurance. Insurance against risk
14resulting from the cost of legal services as defined under
15Class 1(c).
16    Class 3. Fire and Marine, etc.
17    (a) Fire. Insurance against loss or damage by fire, smoke
18and smudge, lightning or other electrical disturbances.
19    (b) Elements. Insurance against loss or damage by
20earthquake, windstorms, cyclone, tornado, tempests, hail,
21frost, snow, ice, sleet, flood, rain, drought or other weather
22or climatic conditions including excess or deficiency of
23moisture, rising of the waters of the ocean or its
24tributaries.
25    (c) War, riot and explosion. Insurance against loss or
26damage by bombardment, invasion, insurrection, riot, strikes,

 

 

HB5493- 14 -LRB103 39189 RPS 69335 b

1civil war or commotion, military or usurped power, or
2explosion (other than explosion of steam boilers and the
3breaking of fly wheels on premises owned, controlled, managed,
4or maintained by the insured).
5    (d) Marine and transportation. Insurance against loss or
6damage to vessels, craft, aircraft, vehicles of every kind,
7(excluding vehicles operating under their own power or while
8in storage not incidental to transportation) as well as all
9goods, freights, cargoes, merchandise, effects, disbursements,
10profits, moneys, bullion, precious stones, securities, choses
11in action, evidences of debt, valuable papers, bottomry and
12respondentia interests and all other kinds of property and
13interests therein, in respect to, appertaining to or in
14connection with any or all risks or perils of navigation,
15transit, or transportation, including war risks, on or under
16any seas or other waters, on land or in the air, or while being
17assembled, packed, crated, baled, compressed or similarly
18prepared for shipment or while awaiting the same or during any
19delays, storage, transshipment, or reshipment incident
20thereto, including marine builder's risks and all personal
21property floater risks; and for loss or damage to persons or
22property in connection with or appertaining to marine, inland
23marine, transit or transportation insurance, including
24liability for loss of or damage to either arising out of or in
25connection with the construction, repair, operation,
26maintenance, or use of the subject matter of such insurance,

 

 

HB5493- 15 -LRB103 39189 RPS 69335 b

1(but not including life insurance or surety bonds); but,
2except as herein specified, shall not mean insurances against
3loss by reason of bodily injury to the person; and insurance
4against loss or damage to precious stones, jewels, jewelry,
5gold, silver and other precious metals whether used in
6business or trade or otherwise and whether the same be in
7course of transportation or otherwise, which shall include
8jewelers' block insurance; and insurance against loss or
9damage to bridges, tunnels and other instrumentalities of
10transportation and communication (excluding buildings, their
11furniture and furnishings, fixed contents and supplies held in
12storage) unless fire, tornado, sprinkler leakage, hail,
13explosion, earthquake, riot and civil commotion are the only
14hazards to be covered; and to piers, wharves, docks and slips,
15excluding the risks of fire, tornado, sprinkler leakage, hail,
16explosion, earthquake, riot and civil commotion; and to other
17aids to navigation and transportation, including dry docks and
18marine railways, against all risk.
19    (e) Vehicle. Insurance against loss or liability resulting
20from or incident to the ownership, maintenance or use of any
21vehicle (motor or otherwise), draft animal or aircraft,
22excluding the liability of the insured for the death, injury
23or disability of another person.
24    (f) Property damage, sprinkler leakage and crop. Insurance
25against the liability of the insured for loss or damage to
26another person's property or property interests from any cause

 

 

HB5493- 16 -LRB103 39189 RPS 69335 b

1enumerated in this class; insurance against loss or damage by
2water entering through leaks or openings in buildings, or from
3the breakage or leakage of a sprinkler, pumps, water pipes,
4plumbing and all tanks, apparatus, conduits and containers
5designed to bring water into buildings or for its storage or
6utilization therein, or caused by the falling of a tank, tank
7platform or supports or against loss or damage from any cause
8to such sprinklers, pumps, water pipes, plumbing, tanks,
9apparatus, conduits or containers; insurance against loss or
10damage from insects, diseases or other causes to trees, crops
11or other products of the soil.
12    (g) Other fire and marine risks. Insurance against any
13other property risk not otherwise specified under Classes 1 or
142, which may lawfully be the subject of insurance and may
15properly be classified under Class 3.
16    (h) Contingent losses. Contingent, consequential and
17indirect coverages wherein the proximate cause of the loss is
18attributable to any of the causes enumerated under Class 3.
19Such coverages shall, for the purpose of classification, be
20included in the specific grouping of the kinds of insurance
21wherein such cause is specified.
22    (i) Legal expense insurance. Insurance against risk
23resulting from the cost of legal services as defined under
24Class 1(c).
25(Source: P.A. 101-81, eff. 7-12-19.)
 

 

 

HB5493- 17 -LRB103 39189 RPS 69335 b

1    (215 ILCS 5/155.23)  (from Ch. 73, par. 767.23)
2    Sec. 155.23. Fraud reporting.
3        (1) Upon written request of the The Director, an
4    insurer is authorized to promulgate reasonable rules
5    requiring insurers, as defined in Section 155.24, or agent
6    authorized by an insurer to act on the insurer's behalf
7    shall release to the Department doing business in the
8    State of Illinois to report factual information in their
9    possession that is pertinent to suspected fraudulent
10    insurance claims, fraudulent insurance applications, or
11    premium fraud, after he has made a determination that the
12    information is necessary to detect fraud or arson. Claim
13    information may include:
14        (a) Dates and description of accident or loss.
15        (b) Any insurance policy relevant to the accident or
16    loss.
17        (c) Name of the insurance company claims adjustor and
18    claims adjustor supervisor processing or reviewing any
19    claim or claims made under any insurance policy relevant
20    to the accident or loss.
21        (d) Name of claimant's or insured's attorney.
22        (e) Name of claimant's or insured's physician, or any
23    person rendering or purporting to render medical
24    treatment.
25        (f) Description of alleged injuries, damage or loss.
26        (g) History of previous claims made by the claimant or

 

 

HB5493- 18 -LRB103 39189 RPS 69335 b

1    insured.
2        (h) Places of medical treatment.
3        (i) Policy premium payment record.
4        (j) Material relating to the investigation of the
5    accident or loss, including statements of any person,
6    proof of loss, and any other relevant evidence.
7        (k) any facts evidencing fraud or arson.
8    The Director shall establish reporting requirements for
9application and premium fraud information reporting by rule.
10    (2) The Director of Insurance may designate one or more
11data processing organizations or governmental agencies to
12assist him in gathering such information and making
13compilations thereof, and may by rule establish the form and
14procedure for gathering and compiling such information. The
15rules may name any organization or agency designated by the
16Director to provide this service, and may in such case provide
17for a fee to be paid by the reporting insurers directly to the
18designated organization or agency to cover any of the costs
19associated with providing this service. After determination by
20the Director of substantial evidence of false or fraudulent
21claims, fraudulent applications, or premium fraud, the
22information shall be forwarded by the Director or the
23Director's designee to the proper law enforcement agency or
24prosecutor. Insurers shall have access to, and may use, the
25information compiled under the provisions of this Section.
26Insurers shall release information to, and shall cooperate

 

 

HB5493- 19 -LRB103 39189 RPS 69335 b

1with, any law enforcement agency requesting such information.
2    In the absence of malice, no insurer, or person who
3furnishes information on its behalf, is liable for damages in
4a civil action or subject to criminal prosecution for any oral
5or written statement made or any other action taken that is
6necessary to supply information required pursuant to this
7Section.
8(Source: P.A. 92-233, eff. 1-1-02.)
 
9    (215 ILCS 5/352)  (from Ch. 73, par. 964)
10    Sec. 352. Scope of Article.
11    (a) Except as provided in subsections (b), (c), (d), and
12(e), and (g), this Article shall apply to all companies
13transacting in this State the kinds of business enumerated in
14clause (b) of Class 1 and clause (a) of Class 2 of Section 4
15and to all policies, contracts, and certificates of insurance
16issued in connection therewith. Nothing in this Article shall
17apply to, or in any way affect policies or contracts described
18in clause (a) of Class 1 of Section 4; however, this Article
19shall apply to policies and contracts which contain benefits
20providing reimbursement for the expenses of long term health
21care which are certified or ordered by a physician including
22but not limited to professional nursing care, custodial
23nursing care, and non-nursing custodial care provided in a
24nursing home or at a residence of the insured.
25    (b) (Blank).

 

 

HB5493- 20 -LRB103 39189 RPS 69335 b

1    (c) A policy issued and delivered in this State that
2provides coverage under that policy for certificate holders
3who are neither residents of nor employed in this State does
4not need to provide to those nonresident certificate holders
5who are not employed in this State the coverages or services
6mandated by this Article.
7    (d) Stop-loss insurance, as defined in clause (b) of Class
81 or clause (a) of Class 2 of Section 4, is exempt from all
9Sections of this Article, except this Section and Sections
10353a, 354, 357.30, and 370. For purposes of this exemption,
11stop-loss insurance is further defined as follows:
12        (1) The policy must be issued to and insure an
13    employer, trustee, or other sponsor of the plan, or the
14    plan itself, but not employees, members, or participants.
15        (2) Payments by the insurer must be made to the
16    employer, trustee, or other sponsors of the plan, or the
17    plan itself, but not to the employees, members,
18    participants, or health care providers.
19    (e) A policy issued or delivered in this State to the
20Department of Healthcare and Family Services (formerly
21Illinois Department of Public Aid) and providing coverage,
22under clause (b) of Class 1 or clause (a) of Class 2 as
23described in Section 4, to persons who are enrolled under
24Article V of the Illinois Public Aid Code or under the
25Children's Health Insurance Program Act is exempt from all
26restrictions, limitations, standards, rules, or regulations

 

 

HB5493- 21 -LRB103 39189 RPS 69335 b

1respecting benefits imposed by or under authority of this
2Code, except those specified by subsection (1) of Section 143,
3Section 370c, and Section 370c.1. Nothing in this subsection,
4however, affects the total medical services available to
5persons eligible for medical assistance under the Illinois
6Public Aid Code.
7    (f) An in-office membership care agreement provided under
8the In-Office Membership Care Act is not insurance for the
9purposes of this Code.
10    (g) The provisions of Sections 356a through 359a, both
11inclusive, shall not apply to or affect:
12        (1) any policy or contract of reinsurance; or
13        (2) life insurance, endowment or annuity contracts, or
14    contracts supplemental thereto, that contain only such
15    provisions relating to accident and sickness insurance
16    that (A) provide additional benefits in case of death or
17    dismemberment or loss of sight by accident, or (B) operate
18    to safeguard such contracts against lapse, or to give a
19    special surrender value or special benefit or an annuity
20    if the insured or annuitant becomes a person with a total
21    and permanent disability, as defined by the contract or
22    supplemental contract.
23(Source: P.A. 101-190, eff. 8-2-19.)
 
24    (215 ILCS 5/352b)
25    Sec. 352b. Excepted benefits exempted Policy of individual

 

 

HB5493- 22 -LRB103 39189 RPS 69335 b

1or group accident and health insurance.
2    (a) Unless specified otherwise and when used in context of
3accident and health insurance policy benefits, coverage,
4terms, or conditions required to be provided under this
5Article, references to any "policy of individual or group
6accident and health insurance", or both, as used in this
7Article, do does not include any coverage or policy that
8provides an excepted benefit, as that term is defined in
9Section 2791(c) of the federal Public Health Service Act (42
10U.S.C. 300gg-91). Nothing in this subsection amendatory Act of
11the 101st General Assembly applies to a policy of liability,
12workers' compensation, automobile medical payment, or limited
13scope dental or vision benefits insurance issued under this
14Code. Nothing in this subsection shall be construed to subject
15excepted benefits outside the scope of Section 352 to any
16requirements of this Article.
17    (b) Unless specified otherwise for a type of excepted
18benefit, nothing in this Article shall require a policy of
19excepted benefits to provide benefits, coverage, terms, or
20conditions in such a manner as to disqualify it from being
21classified under federal law as the type of excepted benefit
22for which its policy forms are filed under Sections 143 and 355
23of this Code.
24(Source: P.A. 101-456, eff. 8-23-19.)
 
25    (215 ILCS 5/356a)  (from Ch. 73, par. 968a)

 

 

HB5493- 23 -LRB103 39189 RPS 69335 b

1    Sec. 356a. Form of policy.
2    (1) No individual policy of accident and health insurance
3shall be delivered or issued for delivery to any person in this
4State state unless:
5        (a) the entire money and other considerations therefor
6    are expressed therein; and
7        (b) the time at which the insurance takes effect and
8    terminates is expressed therein; and
9        (c) it purports to insure only one person, except that
10    a policy may insure, originally or by subsequent
11    amendment, upon the application of an adult member of a
12    family who shall be deemed the policyholder, any 2 two or
13    more eligible members of that family, including husband,
14    wife, dependent children or any children under a specified
15    age which shall not exceed 19 years and any other person
16    dependent upon the policyholder; and
17        (d) the style, arrangement and over-all appearance of
18    the policy give no undue prominence to any portion of the
19    text, and unless every printed portion of the text of the
20    policy and of any endorsements or attached papers is
21    plainly printed in light-faced type of a style in general
22    use, the size of which shall be uniform and not less than
23    ten-point with a lower-case unspaced alphabet length not
24    less than one hundred and twenty-point (the "text" shall
25    include all printed matter except the name and address of
26    the insurer, name or title of the policy, the brief

 

 

HB5493- 24 -LRB103 39189 RPS 69335 b

1    description if any, and captions and subcaptions); and
2        (e) the exceptions and reductions of indemnity are set
3    forth in the policy and, except those which are set forth
4    in Sections 357.1 through 357.30 of this act, are printed,
5    at the insurer's option, either included with the benefit
6    provision to which they apply, or under an appropriate
7    caption such as "EXCEPTIONS", or "EXCEPTIONS AND
8    REDUCTIONS", provided that if an exception or reduction
9    specifically applies only to a particular benefit of the
10    policy, a statement of such exception or reduction shall
11    be included with the benefit provision to which it
12    applies; and
13        (f) each such form, including riders and endorsements,
14    shall be identified by a form number in the lower
15    left-hand corner of the first page thereof; and
16        (g) it contains no provision purporting to make any
17    portion of the charter, rules, constitution, or by-laws of
18    the insurer a part of the policy unless such portion is set
19    forth in full in the policy, except in the case of the
20    incorporation of, or reference to, a statement of rates or
21    classification of risks, or short-rate table filed with
22    the Director.
23    (2) If any policy is issued by an insurer domiciled in this
24state for delivery to a person residing in another state, and
25if the official having responsibility for the administration
26of the insurance laws of such other state shall have advised

 

 

HB5493- 25 -LRB103 39189 RPS 69335 b

1the Director that any such policy is not subject to approval or
2disapproval by such official, the Director may by ruling
3require that such policy meet the standards set forth in
4subsection (1) of this section and in Sections 357.1 through
5357.30.
6(Source: P.A. 76-860.)
 
7    (215 ILCS 5/356b)  (from Ch. 73, par. 968b)
8    Sec. 356b. (a) This Section applies to the hospital and
9medical expense provisions of an individual accident or health
10insurance policy.
11    (b) If a policy provides that coverage of a dependent
12person terminates upon attainment of the limiting age for
13dependent persons specified in the policy, the attainment of
14such limiting age does not operate to terminate the hospital
15and medical coverage of a person who, because of a disabling
16condition that occurred before attainment of the limiting age,
17is incapable of self-sustaining employment and is dependent on
18his or her parents or other care providers for lifetime care
19and supervision.
20    (c) For purposes of subsection (b), "dependent on other
21care providers" is defined as requiring a Community Integrated
22Living Arrangement, group home, supervised apartment, or other
23residential services licensed or certified by the Department
24of Human Services (as successor to the Department of Mental
25Health and Developmental Disabilities), the Department of

 

 

HB5493- 26 -LRB103 39189 RPS 69335 b

1Public Health, or the Department of Healthcare and Family
2Services (formerly Department of Public Aid).
3    (d) The insurer may inquire of the policyholder 2 months
4prior to attainment by a dependent of the limiting age set
5forth in the policy, or at any reasonable time thereafter,
6whether such dependent is in fact a person who has a disability
7and is dependent and, in the absence of proof submitted within
860 days of such inquiry that such dependent is a person who has
9a disability and is dependent may terminate coverage of such
10person at or after attainment of the limiting age. In the
11absence of such inquiry, coverage of any person who has a
12disability and is dependent shall continue through the term of
13such policy or any extension or renewal thereof.
14    (e) This amendatory Act of 1969 is applicable to policies
15issued or renewed more than 60 days after the effective date of
16this amendatory Act of 1969.
17(Source: P.A. 99-143, eff. 7-27-15.)
 
18    (215 ILCS 5/356d)  (from Ch. 73, par. 968d)
19    Sec. 356d. Conversion privileges for insured former
20spouses. (1) No individual policy of accident and health
21insurance providing coverage of hospital and/or medical
22expense on either an expense incurred basis or other than an
23expense incurred basis, which in addition to covering the
24insured also provides coverage to the spouse of the insured
25shall contain a provision for termination of coverage for a

 

 

HB5493- 27 -LRB103 39189 RPS 69335 b

1spouse covered under the policy solely as a result of a break
2in the marital relationship except by reason of an entry of a
3valid judgment of dissolution of marriage between the parties.
4    (2) Every policy which contains a provision for
5termination of coverage of the spouse upon dissolution of
6marriage shall contain a provision to the effect that upon the
7entry of a valid judgment of dissolution of marriage between
8the insured parties the spouse whose marriage was dissolved
9shall be entitled to have issued to him or her, without
10evidence of insurability, upon application made to the company
11within 60 days following the entry of such judgment, and upon
12the payment of the appropriate premium, an individual policy
13of accident and health insurance. Such policy shall provide
14the coverage then being issued by the insurer which is most
15nearly similar to, but not greater than, such terminated
16coverages. Any and all probationary and/or waiting periods set
17forth in such policy shall be considered as being met to the
18extent coverage was in force under the prior policy.
19    (3) The requirements of this Section shall apply to all
20policies delivered or issued for delivery on or after the 60th
21day following the effective date of this Section.
22(Source: P.A. 84-545.)
 
23    (215 ILCS 5/356e)  (from Ch. 73, par. 968e)
24    Sec. 356e. Victims of certain offenses.
25    (1) No individual policy of accident and health insurance,

 

 

HB5493- 28 -LRB103 39189 RPS 69335 b

1which provides benefits for hospital or medical expenses based
2upon the actual expenses incurred, delivered or issued for
3delivery to any person in this State shall contain any
4specific exception to coverage which would preclude the
5payment under that policy of actual expenses incurred in the
6examination and testing of a victim of an offense defined in
7Sections 11-1.20 through 11-1.60 or 12-13 through 12-16 of the
8Criminal Code of 1961 or the Criminal Code of 2012, or an
9attempt to commit such offense to establish that sexual
10contact did occur or did not occur, and to establish the
11presence or absence of sexually transmitted disease or
12infection, and examination and treatment of injuries and
13trauma sustained by a victim of such offense arising out of the
14offense. Every policy of accident and health insurance which
15specifically provides benefits for routine physical
16examinations shall provide full coverage for expenses incurred
17in the examination and testing of a victim of an offense
18defined in Sections 11-1.20 through 11-1.60 or 12-13 through
1912-16 of the Criminal Code of 1961 or the Criminal Code of
202012, or an attempt to commit such offense as set forth in this
21Section. This Section shall not apply to a policy which covers
22hospital and medical expenses for specified illnesses or
23injuries only.
24    (2) For purposes of enabling the recovery of State funds,
25any insurance carrier subject to this Section shall upon
26reasonable demand by the Department of Public Health disclose

 

 

HB5493- 29 -LRB103 39189 RPS 69335 b

1the names and identities of its insureds entitled to benefits
2under this provision to the Department of Public Health
3whenever the Department of Public Health has determined that
4it has paid, or is about to pay, hospital or medical expenses
5for which an insurance carrier is liable under this Section.
6All information received by the Department of Public Health
7under this provision shall be held on a confidential basis and
8shall not be subject to subpoena and shall not be made public
9by the Department of Public Health or used for any purpose
10other than that authorized by this Section.
11    (3) Whenever the Department of Public Health finds that it
12has paid all or part of any hospital or medical expenses which
13an insurance carrier is obligated to pay under this Section,
14the Department of Public Health shall be entitled to receive
15reimbursement for its payments from such insurance carrier
16provided that the Department of Public Health has notified the
17insurance carrier of its claims before the carrier has paid
18such benefits to its insureds or in behalf of its insureds.
19(Source: P.A. 96-1551, eff. 7-1-11; 97-1150, eff. 1-25-13.)
 
20    (215 ILCS 5/356f)  (from Ch. 73, par. 968f)
21    Sec. 356f. No individual policy of accident or health
22insurance or any renewal thereof shall be denied or cancelled
23by the insurer, nor shall any such policy contain any
24exception or exclusion of benefits, solely because the mother
25of the insured has taken diethylstilbestrol, commonly referred

 

 

HB5493- 30 -LRB103 39189 RPS 69335 b

1to as DES.
2(Source: P.A. 81-656.)
 
3    (215 ILCS 5/356K)  (from Ch. 73, par. 968K)
4    Sec. 356K. Coverage for Organ Transplantation Procedures.
5No accident and health insurer providing individual accident
6and health insurance coverage under this Act for hospital or
7medical expenses shall deny reimbursement for an otherwise
8covered expense incurred for any organ transplantation
9procedure solely on the basis that such procedure is deemed
10experimental or investigational unless supported by the
11determination of the Office of Health Care Technology
12Assessment within the Agency for Health Care Policy and
13Research within the federal Department of Health and Human
14Services that such procedure is either experimental or
15investigational or that there is insufficient data or
16experience to determine whether an organ transplantation
17procedure is clinically acceptable. If an accident and health
18insurer has made written request, or had one made on its behalf
19by a national organization, for determination by the Office of
20Health Care Technology Assessment within the Agency for Health
21Care Policy and Research within the federal Department of
22Health and Human Services as to whether a specific organ
23transplantation procedure is clinically acceptable and said
24organization fails to respond to such a request within a
25period of 90 days, the failure to act may be deemed a

 

 

HB5493- 31 -LRB103 39189 RPS 69335 b

1determination that the procedure is deemed to be experimental
2or investigational.
3(Source: P.A. 87-218.)
 
4    (215 ILCS 5/356L)  (from Ch. 73, par. 968L)
5    Sec. 356L. No individual policy of accident or health
6insurance shall include any provision which shall have the
7effect of denying coverage to or on behalf of an insured under
8such policy on the basis of a failure by the insured to file a
9notice of claim within the time period required by the policy,
10provided such failure is caused solely by the physical
11inability or mental incapacity of the insured to file such
12notice of claim because of a period of emergency
13hospitalization.
14(Source: P.A. 86-784.)
 
15    (215 ILCS 5/356r)
16    Sec. 356r. Access to obstetrical and gynecological care
17Woman's principal health care provider.
18    (a) An individual or group policy of accident and health
19insurance or a managed care plan amended, delivered, issued,
20or renewed in this State must not require authorization or
21referral by the plan, issuer, or any person, including a
22primary care provider, for any covered individual who seeks
23coverage for obstetrical or gynecological care provided by any
24licensed or certified participating health care professional

 

 

HB5493- 32 -LRB103 39189 RPS 69335 b

1who specializes in obstetrics or gynecology. after November
214, 1996 that requires an insured or enrollee to designate an
3individual to coordinate care or to control access to health
4care services shall also permit a female insured or enrollee
5to designate a participating woman's principal health care
6provider, and the insurer or managed care plan shall provide
7the following written notice to all female insureds or
8enrollees no later than 120 days after the effective date of
9this amendatory Act of 1998; to all new enrollees at the time
10of enrollment; and thereafter to all existing enrollees at
11least annually, as a part of a regular publication or
12informational mailing:
13
"NOTICE TO ALL FEMALE PLAN MEMBERS:
14
YOUR RIGHT TO SELECT A WOMAN'S PRINCIPAL
15
HEALTH CARE PROVIDER.
16        Illinois law allows you to select "a woman's principal
17    health care provider" in addition to your selection of a
18    primary care physician. A woman's principal health care
19    provider is a physician licensed to practice medicine in
20    all its branches specializing in obstetrics or gynecology
21    or specializing in family practice. A woman's principal
22    health care provider may be seen for care without
23    referrals from your primary care physician. If you have
24    not already selected a woman's principal health care
25    provider, you may do so now or at any other time. You are
26    not required to have or to select a woman's principal

 

 

HB5493- 33 -LRB103 39189 RPS 69335 b

1    health care provider.
2        Your woman's principal health care provider must be a
3    part of your plan. You may get the list of participating
4    obstetricians, gynecologists, and family practice
5    specialists from your employer's employee benefits
6    coordinator, or for your own copy of the current list, you
7    may call [insert plan's toll free number]. The list will
8    be sent to you within 10 days after your call. To designate
9    a woman's principal health care provider from the list,
10    call [insert plan's toll free number] and tell our staff
11    the name of the physician you have selected.".
12If the insurer or managed care plan exercises the option set
13forth in subsection (a-5), the notice shall also state:
14        "Your plan requires that your primary care physician
15    and your woman's principal health care provider have a
16    referral arrangement with one another. If the woman's
17    principal health care provider that you select does not
18    have a referral arrangement with your primary care
19    physician, you will have to select a new primary care
20    physician who has a referral arrangement with your woman's
21    principal health care provider or you may select a woman's
22    principal health care provider who has a referral
23    arrangement with your primary care physician. The list of
24    woman's principal health care providers will also have the
25    names of the primary care physicians and their referral
26    arrangements.".

 

 

HB5493- 34 -LRB103 39189 RPS 69335 b

1    No later than 120 days after the effective date of this
2amendatory Act of 1998, the insurer or managed care plan shall
3provide each employer who has a policy of insurance or a
4managed care plan with the insurer or managed care plan with a
5list of physicians licensed to practice medicine in all its
6branches specializing in obstetrics or gynecology or
7specializing in family practice who have contracted with the
8plan. At the time of enrollment and thereafter within 10 days
9after a request by an insured or enrollee, the insurer or
10managed care plan also shall provide this list directly to the
11insured or enrollee. The list shall include each physician's
12address, telephone number, and specialty. No insurer or plan
13formal or informal policy may restrict a female insured's or
14enrollee's right to designate a woman's principal health care
15provider, except as set forth in subsection (a-5). If the
16female enrollee is an enrollee of a managed care plan under
17contract with the Department of Healthcare and Family
18Services, the physician chosen by the enrollee as her woman's
19principal health care provider must be a Medicaid-enrolled
20provider. This requirement does not require a female insured
21or enrollee to make a selection of a woman's principal health
22care provider. The female insured or enrollee may designate a
23physician licensed to practice medicine in all its branches
24specializing in family practice as her woman's principal
25health care provider.
26    (a-5) If a policy, contract, or certificate requires or

 

 

HB5493- 35 -LRB103 39189 RPS 69335 b

1allows a covered individual to designate a primary care
2provider and provides coverage for any obstetrical or
3gynecological care, the insurer shall provide the notice
4required under 45 CFR 147.138(a)(4) and 149.310(a)(4) in all
5circumstances required under that provision. The insured or
6enrollee may be required by the insurer or managed care plan to
7select a woman's principal health care provider who has a
8referral arrangement with the insured's or enrollee's
9individual who coordinates care or controls access to health
10care services if such referral arrangement exists or to select
11a new individual to coordinate care or to control access to
12health care services who has a referral arrangement with the
13woman's principal health care provider chosen by the insured
14or enrollee, if such referral arrangement exists. If an
15insurer or a managed care plan requires an insured or enrollee
16to select a new physician under this subsection (a-5), the
17insurer or managed care plan must provide the insured or
18enrollee with both options to select a new physician provided
19in this subsection (a-5).
20    Notwithstanding a plan's restrictions of the frequency or
21timing of making designations of primary care providers, a
22female enrollee or insured who is subject to the selection
23requirements of this subsection, may, at any time, effect a
24change in primary care physicians in order to make a selection
25of a woman's principal health care provider.
26    (a-6) The requirements of this Section shall be construed

 

 

HB5493- 36 -LRB103 39189 RPS 69335 b

1in a manner consistent with the requirements for access to and
2notice of obstetrical and gynecological care in 45 CFR 147.138
3and 45 CFR 149.310. If an insurer or managed care plan
4exercises the option in subsection (a-5), the list to be
5provided under subsection (a) shall identify the referral
6arrangements that exist between the individual who coordinates
7care or controls access to health care services and the
8woman's principal health care provider in order to assist the
9female insured or enrollee to make a selection within the
10insurer's or managed care plan's requirement.
11    (b) Nothing in this Section prevents a health insurance
12issuer from requiring a participating obstetrical or
13gynecological health care professional to agree, with respect
14to individuals covered under a policy of accident and health
15insurance, to otherwise adhere to the health insurance
16issuer's policies and procedures, including procedures
17regarding referrals and obtaining prior authorization and
18providing services pursuant to a treatment plan, if any,
19approved by the issuer. If a female insured or enrollee has
20designated a woman's principal health care provider, then the
21insured or enrollee must be given direct access to the woman's
22principal health care provider for services covered by the
23policy or plan without the need for a referral or prior
24approval. Nothing shall prohibit the insurer or managed care
25plan from requiring prior authorization or approval from
26either a primary care provider or the woman's principal health

 

 

HB5493- 37 -LRB103 39189 RPS 69335 b

1care provider for referrals for additional care or services.
2    (c) (Blank). For the purposes of this Section the
3following terms are defined:
4        (1) "Woman's principal health care provider" means a
5    physician licensed to practice medicine in all of its
6    branches specializing in obstetrics or gynecology or
7    specializing in family practice.
8        (2) "Managed care entity" means any entity including a
9    licensed insurance company, hospital or medical service
10    plan, health maintenance organization, limited health
11    service organization, preferred provider organization,
12    third party administrator, an employer or employee
13    organization, or any person or entity that establishes,
14    operates, or maintains a network of participating
15    providers.
16        (3) "Managed care plan" means a plan operated by a
17    managed care entity that provides for the financing of
18    health care services to persons enrolled in the plan
19    through:
20            (A) organizational arrangements for ongoing
21        quality assurance, utilization review programs, or
22        dispute resolution; or
23            (B) financial incentives for persons enrolled in
24        the plan to use the participating providers and
25        procedures covered by the plan.
26        (4) "Participating provider" means a physician who has

 

 

HB5493- 38 -LRB103 39189 RPS 69335 b

1    contracted with an insurer or managed care plan to provide
2    services to insureds or enrollees as defined by the
3    contract.
4    (d) Nothing in this Section shall be construed to preclude
5a health insurance issuer from requiring that a participating
6obstetrical or gynecological health care professional notify
7the covered individual's primary care physician or the issuer
8of treatment decisions or update centralized medical records.
9The original provisions of this Section became law on July 17,
101996 and took effect November 14, 1996, which is 120 days after
11becoming law.
12(Source: P.A. 95-331, eff. 8-21-07.)
 
13    (215 ILCS 5/356s)
14    Sec. 356s. Post-parturition care. An individual or group
15policy of accident and health insurance that provides
16maternity coverage and is amended, delivered, issued, or
17renewed after the effective date of this amendatory Act of
181996 shall provide coverage for the following:
19        (1) a minimum of 48 hours of inpatient care following
20    a vaginal delivery for the mother and the newborn, except
21    as otherwise provided in this Section; or
22        (2) a minimum of 96 hours of inpatient care following
23    a delivery by caesarian section for the mother and
24    newborn, except as otherwise provided in this Section.
25    Coverage may be limited to a A shorter length of hospital

 

 

HB5493- 39 -LRB103 39189 RPS 69335 b

1inpatient care stay for services related to maternity and
2newborn care may be provided if the attending physician
3licensed to practice medicine in all of its branches
4determines, in accordance with the protocols and guidelines
5developed by the American College of Obstetricians and
6Gynecologists or the American Academy of Pediatrics, that the
7mother and the newborn meet the appropriate guidelines for
8that length of stay based upon evaluation of the mother and
9newborn and the coverage and availability of a post-discharge
10physician office visit or in-home nurse visit to verify the
11condition of the infant in the first 48 hours after discharge.
12(Source: P.A. 89-513, eff. 9-15-96; 90-14, eff. 7-1-97.)
 
13    (215 ILCS 5/356z.3)
14    Sec. 356z.3. Disclosure of limited benefit. An insurer
15that issues, delivers, amends, or renews an individual or
16group policy of accident and health insurance in this State
17after the effective date of this amendatory Act of the 92nd
18General Assembly and arranges, contracts with, or administers
19contracts with a provider whereby beneficiaries are provided
20an incentive to use the services of such provider must include
21the following disclosure on its contracts and evidences of
22coverage: "WARNING, LIMITED BENEFITS WILL BE PAID WHEN
23NON-PARTICIPATING PROVIDERS ARE USED. YOU CAN EXPECT TO PAY
24MORE THAN THE COST-SHARING AMOUNT DEFINED IN THE POLICY IN
25NON-EMERGENCY SITUATIONS. Except in limited situations

 

 

HB5493- 40 -LRB103 39189 RPS 69335 b

1governed by the federal No Surprises Act or Section 356z.3a of
2the Illinois Insurance Code (215 ILCS 5/356z.3a),
3non-participating providers furnishing non-emergency services
4may bill members for any amount up to the billed charge after
5the plan has paid its portion of the bill. If you elect to use
6a non-participating provider, plan benefit payments will be
7determined according to your policy's fee schedule, usual and
8customary charge (which is determined by comparing charges for
9similar services adjusted to the geographical area where the
10services are performed), or other method as defined by the
11policy. Participating providers have agreed to ONLY bill
12members the cost-sharing amounts. You should be aware that
13when you elect to utilize the services of a non-participating
14provider for a covered service in non-emergency situations,
15benefit payments to such non-participating provider are not
16based upon the amount billed. The basis of your benefit
17payment will be determined according to your policy's fee
18schedule, usual and customary charge (which is determined by
19comparing charges for similar services adjusted to the
20geographical area where the services are performed), or other
21method as defined by the policy. YOU CAN EXPECT TO PAY MORE
22THAN THE COINSURANCE AMOUNT DEFINED IN THE POLICY AFTER THE
23PLAN HAS PAID ITS REQUIRED PORTION. Non-participating
24providers may bill members for any amount up to the billed
25charge after the plan has paid its portion of the bill, except
26as provided in Section 356z.3a of the Illinois Insurance Code

 

 

HB5493- 41 -LRB103 39189 RPS 69335 b

1for covered services received at a participating health care
2facility from a nonparticipating provider that are: (a)
3ancillary services, (b) items or services furnished as a
4result of unforeseen, urgent medical needs that arise at the
5time the item or service is furnished, or (c) items or services
6received when the facility or the non-participating provider
7fails to satisfy the notice and consent criteria specified
8under Section 356z.3a. Participating providers have agreed to
9accept discounted payments for services with no additional
10billing to the member other than co-insurance and deductible
11amounts. You may obtain further information about the
12participating status of professional providers and information
13on out-of-pocket expenses by calling the toll-free toll free
14telephone number on your identification card.".
15(Source: P.A. 102-901, eff. 1-1-23.)
 
16    (215 ILCS 5/356z.33)
17    (Text of Section before amendment by P.A. 103-454)
18    Sec. 356z.33. Coverage for epinephrine injectors. A group
19or individual policy of accident and health insurance or a
20managed care plan that is amended, delivered, issued, or
21renewed on or after January 1, 2020 (the effective date of
22Public Act 101-281) shall provide coverage for medically
23necessary epinephrine injectors for persons 18 years of age or
24under. As used in this Section, "epinephrine injector" has the
25meaning given to that term in Section 5 of the Epinephrine

 

 

HB5493- 42 -LRB103 39189 RPS 69335 b

1Injector Act.
2(Source: P.A. 101-281, eff. 1-1-20; 102-558, eff. 8-20-21.)
 
3    (Text of Section after amendment by P.A. 103-454)
4    Sec. 356z.33. Coverage for epinephrine injectors.
5    (a) A group or individual policy of accident and health
6insurance or a managed care plan that is amended, delivered,
7issued, or renewed on or after January 1, 2020 (the effective
8date of Public Act 101-281) shall provide coverage for
9medically necessary epinephrine injectors for persons 18 years
10of age or under. As used in this Section, "epinephrine
11injector" has the meaning given to that term in Section 5 of
12the Epinephrine Injector Act.
13    (b) An insurer that provides coverage for medically
14necessary epinephrine injectors shall limit the total amount
15that an insured is required to pay for a twin-pack of medically
16necessary epinephrine injectors at an amount not to exceed
17$60, regardless of the type of epinephrine injector; except
18that this provision does not apply to the extent such coverage
19would disqualify a high-deductible health plan from
20eligibility for a health savings account pursuant to Section
21223 of the Internal Revenue Code (26 U.S.C. 223).
22    (c) Nothing in this Section prevents an insurer from
23reducing an insured's cost sharing by an amount greater than
24the amount specified in subsection (b).
25    (d) The Department may adopt rules as necessary to

 

 

HB5493- 43 -LRB103 39189 RPS 69335 b

1implement and administer this Section.
2(Source: P.A. 102-558, eff. 8-20-21; 103-454, eff. 1-1-25.)
 
3    (215 ILCS 5/367a)  (from Ch. 73, par. 979a)
4    Sec. 367a. Blanket accident and health insurance.
5    (1) Blanket accident and health insurance is that form of
6accident and health insurance covering special groups of
7persons as enumerated in one of the following paragraphs (a)
8to (g), inclusive:
9        (a) Under a policy or contract issued to any carrier
10    for hire, which shall be deemed the policyholder, covering
11    a group defined as all persons who may become passengers
12    on such carrier.
13        (b) Under a policy or contract issued to an employer,
14    who shall be deemed the policyholder, covering all
15    employees or any group of employees defined by reference
16    to exceptional hazards incident to such employment.
17        (c) Under a policy or contract issued to a college,
18    school, or other institution of learning or to the head or
19    principal thereof, who or which shall be deemed the
20    policyholder, covering students or teachers. However,
21    student health insurance coverage, as defined in 45 CFR
22    147.145, shall remain subject to the standards and
23    requirements for individual health insurance coverage
24    except where inconsistent with that regulation. Student
25    health insurance coverage shall not be subject to the

 

 

HB5493- 44 -LRB103 39189 RPS 69335 b

1    Short-Term, Limited-Duration Health Insurance Coverage
2    Act. An insurer providing student health insurance
3    coverage or a policy or contract covering students for
4    limited-scope dental or vision under 45 CFR 148.220 shall
5    require an individual application or enrollment form and
6    shall furnish each insured individual a certificate, which
7    shall have been approved by the Director under Section
8    355.
9        (d) Under a policy or contract issued in the name of
10    any volunteer fire department, first aid, or other such
11    volunteer group, which shall be deemed the policyholder,
12    covering all of the members of such department or group.
13        (e) Under a policy or contract issued to a creditor,
14    who shall be deemed the policyholder, to insure debtors of
15    the creditors; Provided, however, that in the case of a
16    loan which is subject to the Small Loans Act, no insurance
17    premium or other cost shall be directly or indirectly
18    charged or assessed against, or collected or received from
19    the borrower.
20        (f) Under a policy or contract issued to a sports team
21    or to a camp, which team or camp sponsor shall be deemed
22    the policyholder, covering members or campers.
23        (g) Under a policy or contract issued to any other
24    substantially similar group which, in the discretion of
25    the Director, may be subject to the issuance of a blanket
26    accident and health policy or contract.

 

 

HB5493- 45 -LRB103 39189 RPS 69335 b

1    (2) Any insurance company authorized to write accident and
2health insurance in this state shall have the power to issue
3blanket accident and health insurance. No such blanket policy
4may be issued or delivered in this State unless a copy of the
5form thereof shall have been filed in accordance with Section
6355, and it contains in substance such of those provisions
7contained in Sections 357.1 through 357.30 as may be
8applicable to blanket accident and health insurance and the
9following provisions:
10        (a) A provision that the policy and the application
11    shall constitute the entire contract between the parties,
12    and that all statements made by the policyholder shall, in
13    absence of fraud, be deemed representations and not
14    warranties, and that no such statements shall be used in
15    defense to a claim under the policy, unless it is
16    contained in a written application.
17        (b) A provision that to the group or class thereof
18    originally insured shall be added from time to time all
19    new persons or individuals eligible for coverage.
20    (3) An individual application shall not be required from a
21person covered under a blanket accident or health policy or
22contract, nor shall it be necessary for the insurer to furnish
23each person a certificate.
24    (3.5) Subsection (3) does not apply to major medical
25insurance, or to any excepted benefits or short-term,
26limited-duration health insurance coverage for which an

 

 

HB5493- 46 -LRB103 39189 RPS 69335 b

1insured individual pays premiums or contributions. In those
2cases, the insurer shall require an individual application or
3enrollment form and shall furnish each insured individual a
4certificate, which shall have been approved by the Director
5under Section 355 of this Code.
6    (4) All benefits under any blanket accident and health
7policy shall be payable to the person insured, or to his
8designated beneficiary or beneficiaries, or to his or her
9estate, except that if the person insured be a minor or person
10under legal disability, such benefits may be made payable to
11his or her parent, guardian, or other person actually
12supporting him or her. Provided further, however, that the
13policy may provide that all or any portion of any indemnities
14provided by any such policy on account of hospital, nursing,
15medical or surgical services may, at the insurer's option, be
16paid directly to the hospital or person rendering such
17services; but the policy may not require that the service be
18rendered by a particular hospital or person. Payment so made
19shall discharge the insurer's obligation with respect to the
20amount of insurance so paid.
21    (5) Nothing contained in this section shall be deemed to
22affect the legal liability of policyholders for the death of
23or injury to, any such member of such group.
24(Source: P.A. 83-1362.)
 
25    (215 ILCS 5/370e)  (from Ch. 73, par. 982e)

 

 

HB5493- 47 -LRB103 39189 RPS 69335 b

1    Sec. 370e. Companies which issue group accident and health
2policies or blanket accident and health plans to employer
3groups in this State shall provide the employer with notice of
4termination of a group or blanket accident and health plan
5because of the employer's failure to pay the premium when due.
6The insurance company shall file send a copy of such notice
7with to the Department in an electronic format either through
8the System for Electronic Rate and Form Filing (SERFF) or as
9otherwise prescribed by the Director.
10(Source: P.A. 83-1006.)
 
11    (215 ILCS 5/370i)  (from Ch. 73, par. 982i)
12    Sec. 370i. Policies, agreements or arrangements with
13incentives or limits on reimbursement authorized.
14    (a) Policies, agreements or arrangements issued under this
15Article may not contain terms or conditions that would operate
16unreasonably to restrict the access and availability of health
17care services for the insured.
18    (b) An insurer or administrator may:
19        (1) enter into agreements with certain providers of
20    its choice relating to health care services which may be
21    rendered to insureds or beneficiaries of the insurer or
22    administrator, including agreements relating to the
23    amounts to be charged the insureds or beneficiaries for
24    services rendered;
25        (2) issue or administer programs, policies or

 

 

HB5493- 48 -LRB103 39189 RPS 69335 b

1    subscriber contracts in this State that include incentives
2    for the insured or beneficiary to utilize the services of
3    a provider which has entered into an agreement with the
4    insurer or administrator pursuant to paragraph (1) above.
5    (c) (Blank). After the effective date of this amendatory
6Act of the 92nd General Assembly, any insurer that arranges,
7contracts with, or administers contracts with a provider
8whereby beneficiaries are provided an incentive to use the
9services of such provider must include the following
10disclosure on its contracts and evidences of coverage:
11"WARNING, LIMITED BENEFITS WILL BE PAID WHEN NON-PARTICIPATING
12PROVIDERS ARE USED. You should be aware that when you elect to
13utilize the services of a non-participating provider for a
14covered service in non-emergency situations, benefit payments
15to such non-participating provider are not based upon the
16amount billed. The basis of your benefit payment will be
17determined according to your policy's fee schedule, usual and
18customary charge (which is determined by comparing charges for
19similar services adjusted to the geographical area where the
20services are performed), or other method as defined by the
21policy. YOU CAN EXPECT TO PAY MORE THAN THE COINSURANCE AMOUNT
22DEFINED IN THE POLICY AFTER THE PLAN HAS PAID ITS REQUIRED
23PORTION. Non-participating providers may bill members for any
24amount up to the billed charge after the plan has paid its
25portion of the bill. Participating providers have agreed to
26accept discounted payments for services with no additional

 

 

HB5493- 49 -LRB103 39189 RPS 69335 b

1billing to the member other than co-insurance and deductible
2amounts. You may obtain further information about the
3participating status of professional providers and information
4on out-of-pocket expenses by calling the toll free telephone
5number on your identification card.".
6(Source: P.A. 92-579, eff. 1-1-03.)
 
7    (215 ILCS 5/408)  (from Ch. 73, par. 1020)
8    (Text of Section before amendment by P.A. 103-75)
9    Sec. 408. Fees and charges.
10    (1) The Director shall charge, collect and give proper
11acquittances for the payment of the following fees and
12charges:
13        (a) For filing all documents submitted for the
14    incorporation or organization or certification of a
15    domestic company, except for a fraternal benefit society,
16    $2,000.
17        (b) For filing all documents submitted for the
18    incorporation or organization of a fraternal benefit
19    society, $500.
20        (c) For filing amendments to articles of incorporation
21    and amendments to declaration of organization, except for
22    a fraternal benefit society, a mutual benefit association,
23    a burial society or a farm mutual, $200.
24        (d) For filing amendments to articles of incorporation
25    of a fraternal benefit society, a mutual benefit

 

 

HB5493- 50 -LRB103 39189 RPS 69335 b

1    association or a burial society, $100.
2        (e) For filing amendments to articles of incorporation
3    of a farm mutual, $50.
4        (f) For filing bylaws or amendments thereto, $50.
5        (g) For filing agreement of merger or consolidation:
6            (i) for a domestic company, except for a fraternal
7        benefit society, a mutual benefit association, a
8        burial society, or a farm mutual, $2,000.
9            (ii) for a foreign or alien company, except for a
10        fraternal benefit society, $600.
11            (iii) for a fraternal benefit society, a mutual
12        benefit association, a burial society, or a farm
13        mutual, $200.
14        (h) For filing agreements of reinsurance by a domestic
15    company, $200.
16        (i) For filing all documents submitted by a foreign or
17    alien company to be admitted to transact business or
18    accredited as a reinsurer in this State, except for a
19    fraternal benefit society, $5,000.
20        (j) For filing all documents submitted by a foreign or
21    alien fraternal benefit society to be admitted to transact
22    business in this State, $500.
23        (k) For filing declaration of withdrawal of a foreign
24    or alien company, $50.
25        (l) For filing annual statement by a domestic company,
26    except a fraternal benefit society, a mutual benefit

 

 

HB5493- 51 -LRB103 39189 RPS 69335 b

1    association, a burial society, or a farm mutual, $200.
2        (m) For filing annual statement by a domestic
3    fraternal benefit society, $100.
4        (n) For filing annual statement by a farm mutual, a
5    mutual benefit association, or a burial society, $50.
6        (o) For issuing a certificate of authority or renewal
7    thereof except to a foreign fraternal benefit society,
8    $400.
9        (p) For issuing a certificate of authority or renewal
10    thereof to a foreign fraternal benefit society, $200.
11        (q) For issuing an amended certificate of authority,
12    $50.
13        (r) For each certified copy of certificate of
14    authority, $20.
15        (s) For each certificate of deposit, or valuation, or
16    compliance or surety certificate, $20.
17        (t) For copies of papers or records per page, $1.
18        (u) For each certification to copies of papers or
19    records, $10.
20        (v) For multiple copies of documents or certificates
21    listed in subparagraphs (r), (s), and (u) of paragraph (1)
22    of this Section, $10 for the first copy of a certificate of
23    any type and $5 for each additional copy of the same
24    certificate requested at the same time, unless, pursuant
25    to paragraph (2) of this Section, the Director finds these
26    additional fees excessive.

 

 

HB5493- 52 -LRB103 39189 RPS 69335 b

1        (w) For issuing a permit to sell shares or increase
2    paid-up capital:
3            (i) in connection with a public stock offering,
4        $300;
5            (ii) in any other case, $100.
6        (x) For issuing any other certificate required or
7    permissible under the law, $50.
8        (y) For filing a plan of exchange of the stock of a
9    domestic stock insurance company, a plan of
10    demutualization of a domestic mutual company, or a plan of
11    reorganization under Article XII, $2,000.
12        (z) For filing a statement of acquisition of a
13    domestic company as defined in Section 131.4 of this Code,
14    $2,000.
15        (aa) For filing an agreement to purchase the business
16    of an organization authorized under the Dental Service
17    Plan Act or the Voluntary Health Services Plans Act or of a
18    health maintenance organization or a limited health
19    service organization, $2,000.
20        (bb) For filing a statement of acquisition of a
21    foreign or alien insurance company as defined in Section
22    131.12a of this Code, $1,000.
23        (cc) For filing a registration statement as required
24    in Sections 131.13 and 131.14, the notification as
25    required by Sections 131.16, 131.20a, or 141.4, or an
26    agreement or transaction required by Sections 124.2(2),

 

 

HB5493- 53 -LRB103 39189 RPS 69335 b

1    141, 141a, or 141.1, $200.
2        (dd) For filing an application for licensing of:
3            (i) a religious or charitable risk pooling trust
4        or a workers' compensation pool, $1,000;
5            (ii) a workers' compensation service company,
6        $500;
7            (iii) a self-insured automobile fleet, $200; or
8            (iv) a renewal of or amendment of any license
9        issued pursuant to (i), (ii), or (iii) above, $100.
10        (ee) For filing articles of incorporation for a
11    syndicate to engage in the business of insurance through
12    the Illinois Insurance Exchange, $2,000.
13        (ff) For filing amended articles of incorporation for
14    a syndicate engaged in the business of insurance through
15    the Illinois Insurance Exchange, $100.
16        (gg) For filing articles of incorporation for a
17    limited syndicate to join with other subscribers or
18    limited syndicates to do business through the Illinois
19    Insurance Exchange, $1,000.
20        (hh) For filing amended articles of incorporation for
21    a limited syndicate to do business through the Illinois
22    Insurance Exchange, $100.
23        (ii) For a permit to solicit subscriptions to a
24    syndicate or limited syndicate, $100.
25        (jj) For the filing of each form as required in
26    Section 143 of this Code, $50 per form. Informational and

 

 

HB5493- 54 -LRB103 39189 RPS 69335 b

1    advertising filings shall be $25 per filing. The fee for
2    advisory and rating organizations shall be $200 per form.
3            (i) For the purposes of the form filing fee,
4        filings made on insert page basis will be considered
5        one form at the time of its original submission.
6        Changes made to a form subsequent to its approval
7        shall be considered a new filing.
8            (ii) Only one fee shall be charged for a form,
9        regardless of the number of other forms or policies
10        with which it will be used.
11            (iii) Fees charged for a policy filed as it will be
12        issued regardless of the number of forms comprising
13        that policy shall not exceed $1,500. For advisory or
14        rating organizations, fees charged for a policy filed
15        as it will be issued regardless of the number of forms
16        comprising that policy shall not exceed $2,500.
17            (iv) The Director may by rule exempt forms from
18        such fees.
19        (kk) For filing an application for licensing of a
20    reinsurance intermediary, $500.
21        (ll) For filing an application for renewal of a
22    license of a reinsurance intermediary, $200.
23        (mm) For filing a plan of division of a domestic stock
24    company under Article IIB, $100,000 $10,000.
25        (nn) For filing all documents submitted by a foreign
26    or alien company to be a certified reinsurer in this

 

 

HB5493- 55 -LRB103 39189 RPS 69335 b

1    State, except for a fraternal benefit society, $1,000.
2        (oo) For filing a renewal by a foreign or alien
3    company to be a certified reinsurer in this State, except
4    for a fraternal benefit society, $400.
5        (pp) For filing all documents submitted by a reinsurer
6    domiciled in a reciprocal jurisdiction, $1,000.
7        (qq) For filing a renewal by a reinsurer domiciled in
8    a reciprocal jurisdiction, $400.
9        (rr) For registering a captive management company or
10    renewal thereof, $50.
11    (2) When printed copies or numerous copies of the same
12paper or records are furnished or certified, the Director may
13reduce such fees for copies if he finds them excessive. He may,
14when he considers it in the public interest, furnish without
15charge to state insurance departments and persons other than
16companies, copies or certified copies of reports of
17examinations and of other papers and records.
18    (3) The expenses incurred in any performance examination
19authorized by law shall be paid by the company or person being
20examined. The charge shall be reasonably related to the cost
21of the examination including but not limited to compensation
22of examiners, electronic data processing costs, supervision
23and preparation of an examination report and lodging and
24travel expenses. All lodging and travel expenses shall be in
25accord with the applicable travel regulations as published by
26the Department of Central Management Services and approved by

 

 

HB5493- 56 -LRB103 39189 RPS 69335 b

1the Governor's Travel Control Board, except that out-of-state
2lodging and travel expenses related to examinations authorized
3under Section 132 shall be in accordance with travel rates
4prescribed under paragraph 301-7.2 of the Federal Travel
5Regulations, 41 CFR C.F.R. 301-7.2, for reimbursement of
6subsistence expenses incurred during official travel. All
7lodging and travel expenses may be reimbursed directly upon
8authorization of the Director. With the exception of the
9direct reimbursements authorized by the Director, all
10performance examination charges collected by the Department
11shall be paid to the Insurance Producer Administration Fund,
12however, the electronic data processing costs incurred by the
13Department in the performance of any examination shall be
14billed directly to the company being examined for payment to
15the Technology Management Revolving Fund.
16    (4) At the time of any service of process on the Director
17as attorney for such service, the Director shall charge and
18collect the sum of $40, which may be recovered as taxable costs
19by the party to the suit or action causing such service to be
20made if he prevails in such suit or action.
21    (5) (a) The costs incurred by the Department of Insurance
22in conducting any hearing authorized by law shall be assessed
23against the parties to the hearing in such proportion as the
24Director of Insurance may determine upon consideration of all
25relevant circumstances including: (1) the nature of the
26hearing; (2) whether the hearing was instigated by, or for the

 

 

HB5493- 57 -LRB103 39189 RPS 69335 b

1benefit of a particular party or parties; (3) whether there is
2a successful party on the merits of the proceeding; and (4) the
3relative levels of participation by the parties.
4    (b) For purposes of this subsection (5) costs incurred
5shall mean the hearing officer fees, court reporter fees, and
6travel expenses of Department of Insurance officers and
7employees; provided however, that costs incurred shall not
8include hearing officer fees or court reporter fees unless the
9Department has retained the services of independent
10contractors or outside experts to perform such functions.
11    (c) The Director shall make the assessment of costs
12incurred as part of the final order or decision arising out of
13the proceeding; provided, however, that such order or decision
14shall include findings and conclusions in support of the
15assessment of costs. This subsection (5) shall not be
16construed as permitting the payment of travel expenses unless
17calculated in accordance with the applicable travel
18regulations of the Department of Central Management Services,
19as approved by the Governor's Travel Control Board. The
20Director as part of such order or decision shall require all
21assessments for hearing officer fees and court reporter fees,
22if any, to be paid directly to the hearing officer or court
23reporter by the party(s) assessed for such costs. The
24assessments for travel expenses of Department officers and
25employees shall be reimbursable to the Director of Insurance
26for deposit to the fund out of which those expenses had been

 

 

HB5493- 58 -LRB103 39189 RPS 69335 b

1paid.
2    (d) The provisions of this subsection (5) shall apply in
3the case of any hearing conducted by the Director of Insurance
4not otherwise specifically provided for by law.
5    (6) The Director shall charge and collect an annual
6financial regulation fee from every domestic company for
7examination and analysis of its financial condition and to
8fund the internal costs and expenses of the Interstate
9Insurance Receivership Commission as may be allocated to the
10State of Illinois and companies doing an insurance business in
11this State pursuant to Article X of the Interstate Insurance
12Receivership Compact. The fee shall be the greater fixed
13amount based upon the combination of nationwide direct premium
14income and nationwide reinsurance assumed premium income or
15upon admitted assets calculated under this subsection as
16follows:
17        (a) Combination of nationwide direct premium income
18    and nationwide reinsurance assumed premium.
19            (i) $150, if the premium is less than $500,000 and
20        there is no reinsurance assumed premium;
21            (ii) $750, if the premium is $500,000 or more, but
22        less than $5,000,000 and there is no reinsurance
23        assumed premium; or if the premium is less than
24        $5,000,000 and the reinsurance assumed premium is less
25        than $10,000,000;
26            (iii) $3,750, if the premium is less than

 

 

HB5493- 59 -LRB103 39189 RPS 69335 b

1        $5,000,000 and the reinsurance assumed premium is
2        $10,000,000 or more;
3            (iv) $7,500, if the premium is $5,000,000 or more,
4        but less than $10,000,000;
5            (v) $18,000, if the premium is $10,000,000 or
6        more, but less than $25,000,000;
7            (vi) $22,500, if the premium is $25,000,000 or
8        more, but less than $50,000,000;
9            (vii) $30,000, if the premium is $50,000,000 or
10        more, but less than $100,000,000;
11            (viii) $37,500, if the premium is $100,000,000 or
12        more.
13        (b) Admitted assets.
14            (i) $150, if admitted assets are less than
15        $1,000,000;
16            (ii) $750, if admitted assets are $1,000,000 or
17        more, but less than $5,000,000;
18            (iii) $3,750, if admitted assets are $5,000,000 or
19        more, but less than $25,000,000;
20            (iv) $7,500, if admitted assets are $25,000,000 or
21        more, but less than $50,000,000;
22            (v) $18,000, if admitted assets are $50,000,000 or
23        more, but less than $100,000,000;
24            (vi) $22,500, if admitted assets are $100,000,000
25        or more, but less than $500,000,000;
26            (vii) $30,000, if admitted assets are $500,000,000

 

 

HB5493- 60 -LRB103 39189 RPS 69335 b

1        or more, but less than $1,000,000,000;
2            (viii) $37,500, if admitted assets are
3        $1,000,000,000 or more.
4        (c) The sum of financial regulation fees charged to
5    the domestic companies of the same affiliated group shall
6    not exceed $250,000 in the aggregate in any single year
7    and shall be billed by the Director to the member company
8    designated by the group.
9    (7) The Director shall charge and collect an annual
10financial regulation fee from every foreign or alien company,
11except fraternal benefit societies, for the examination and
12analysis of its financial condition and to fund the internal
13costs and expenses of the Interstate Insurance Receivership
14Commission as may be allocated to the State of Illinois and
15companies doing an insurance business in this State pursuant
16to Article X of the Interstate Insurance Receivership Compact.
17The fee shall be a fixed amount based upon Illinois direct
18premium income and nationwide reinsurance assumed premium
19income in accordance with the following schedule:
20        (a) $150, if the premium is less than $500,000 and
21    there is no reinsurance assumed premium;
22        (b) $750, if the premium is $500,000 or more, but less
23    than $5,000,000 and there is no reinsurance assumed
24    premium; or if the premium is less than $5,000,000 and the
25    reinsurance assumed premium is less than $10,000,000;
26        (c) $3,750, if the premium is less than $5,000,000 and

 

 

HB5493- 61 -LRB103 39189 RPS 69335 b

1    the reinsurance assumed premium is $10,000,000 or more;
2        (d) $7,500, if the premium is $5,000,000 or more, but
3    less than $10,000,000;
4        (e) $18,000, if the premium is $10,000,000 or more,
5    but less than $25,000,000;
6        (f) $22,500, if the premium is $25,000,000 or more,
7    but less than $50,000,000;
8        (g) $30,000, if the premium is $50,000,000 or more,
9    but less than $100,000,000;
10        (h) $37,500, if the premium is $100,000,000 or more.
11    The sum of financial regulation fees under this subsection
12(7) charged to the foreign or alien companies within the same
13affiliated group shall not exceed $250,000 in the aggregate in
14any single year and shall be billed by the Director to the
15member company designated by the group.
16    (8) Beginning January 1, 1992, the financial regulation
17fees imposed under subsections (6) and (7) of this Section
18shall be paid by each company or domestic affiliated group
19annually. After January 1, 1994, the fee shall be billed by
20Department invoice based upon the company's premium income or
21admitted assets as shown in its annual statement for the
22preceding calendar year. The invoice is due upon receipt and
23must be paid no later than June 30 of each calendar year. All
24financial regulation fees collected by the Department shall be
25paid to the Insurance Financial Regulation Fund. The
26Department may not collect financial examiner per diem charges

 

 

HB5493- 62 -LRB103 39189 RPS 69335 b

1from companies subject to subsections (6) and (7) of this
2Section undergoing financial examination after June 30, 1992.
3    (9) In addition to the financial regulation fee required
4by this Section, a company undergoing any financial
5examination authorized by law shall pay the following costs
6and expenses incurred by the Department: electronic data
7processing costs, the expenses authorized under Section 131.21
8and subsection (d) of Section 132.4 of this Code, and lodging
9and travel expenses.
10    Electronic data processing costs incurred by the
11Department in the performance of any examination shall be
12billed directly to the company undergoing examination for
13payment to the Technology Management Revolving Fund. Except
14for direct reimbursements authorized by the Director or direct
15payments made under Section 131.21 or subsection (d) of
16Section 132.4 of this Code, all financial regulation fees and
17all financial examination charges collected by the Department
18shall be paid to the Insurance Financial Regulation Fund.
19    All lodging and travel expenses shall be in accordance
20with applicable travel regulations published by the Department
21of Central Management Services and approved by the Governor's
22Travel Control Board, except that out-of-state lodging and
23travel expenses related to examinations authorized under
24Sections 132.1 through 132.7 shall be in accordance with
25travel rates prescribed under paragraph 301-7.2 of the Federal
26Travel Regulations, 41 CFR C.F.R. 301-7.2, for reimbursement

 

 

HB5493- 63 -LRB103 39189 RPS 69335 b

1of subsistence expenses incurred during official travel. All
2lodging and travel expenses may be reimbursed directly upon
3the authorization of the Director.
4    In the case of an organization or person not subject to the
5financial regulation fee, the expenses incurred in any
6financial examination authorized by law shall be paid by the
7organization or person being examined. The charge shall be
8reasonably related to the cost of the examination including,
9but not limited to, compensation of examiners and other costs
10described in this subsection.
11    (10) Any company, person, or entity failing to make any
12payment of $150 or more as required under this Section shall be
13subject to the penalty and interest provisions provided for in
14subsections (4) and (7) of Section 412.
15    (11) Unless otherwise specified, all of the fees collected
16under this Section shall be paid into the Insurance Financial
17Regulation Fund.
18    (12) For purposes of this Section:
19        (a) "Domestic company" means a company as defined in
20    Section 2 of this Code which is incorporated or organized
21    under the laws of this State, and in addition includes a
22    not-for-profit corporation authorized under the Dental
23    Service Plan Act or the Voluntary Health Services Plans
24    Act, a health maintenance organization, and a limited
25    health service organization.
26        (b) "Foreign company" means a company as defined in

 

 

HB5493- 64 -LRB103 39189 RPS 69335 b

1    Section 2 of this Code which is incorporated or organized
2    under the laws of any state of the United States other than
3    this State and in addition includes a health maintenance
4    organization and a limited health service organization
5    which is incorporated or organized under the laws of any
6    state of the United States other than this State.
7        (c) "Alien company" means a company as defined in
8    Section 2 of this Code which is incorporated or organized
9    under the laws of any country other than the United
10    States.
11        (d) "Fraternal benefit society" means a corporation,
12    society, order, lodge or voluntary association as defined
13    in Section 282.1 of this Code.
14        (e) "Mutual benefit association" means a company,
15    association or corporation authorized by the Director to
16    do business in this State under the provisions of Article
17    XVIII of this Code.
18        (f) "Burial society" means a person, firm,
19    corporation, society or association of individuals
20    authorized by the Director to do business in this State
21    under the provisions of Article XIX of this Code.
22        (g) "Farm mutual" means a district, county and
23    township mutual insurance company authorized by the
24    Director to do business in this State under the provisions
25    of the Farm Mutual Insurance Company Act of 1986.
26(Source: P.A. 102-775, eff. 5-13-22.)
 

 

 

HB5493- 65 -LRB103 39189 RPS 69335 b

1    (Text of Section after amendment by P.A. 103-75)
2    Sec. 408. Fees and charges.
3    (1) The Director shall charge, collect and give proper
4acquittances for the payment of the following fees and
5charges:
6        (a) For filing all documents submitted for the
7    incorporation or organization or certification of a
8    domestic company, except for a fraternal benefit society,
9    $2,000.
10        (b) For filing all documents submitted for the
11    incorporation or organization of a fraternal benefit
12    society, $500.
13        (c) For filing amendments to articles of incorporation
14    and amendments to declaration of organization, except for
15    a fraternal benefit society, a mutual benefit association,
16    a burial society or a farm mutual, $200.
17        (d) For filing amendments to articles of incorporation
18    of a fraternal benefit society, a mutual benefit
19    association or a burial society, $100.
20        (e) For filing amendments to articles of incorporation
21    of a farm mutual, $50.
22        (f) For filing bylaws or amendments thereto, $50.
23        (g) For filing agreement of merger or consolidation:
24            (i) for a domestic company, except for a fraternal
25        benefit society, a mutual benefit association, a

 

 

HB5493- 66 -LRB103 39189 RPS 69335 b

1        burial society, or a farm mutual, $2,000.
2            (ii) for a foreign or alien company, except for a
3        fraternal benefit society, $600.
4            (iii) for a fraternal benefit society, a mutual
5        benefit association, a burial society, or a farm
6        mutual, $200.
7        (h) For filing agreements of reinsurance by a domestic
8    company, $200.
9        (i) For filing all documents submitted by a foreign or
10    alien company to be admitted to transact business or
11    accredited as a reinsurer in this State, except for a
12    fraternal benefit society, $5,000.
13        (j) For filing all documents submitted by a foreign or
14    alien fraternal benefit society to be admitted to transact
15    business in this State, $500.
16        (k) For filing declaration of withdrawal of a foreign
17    or alien company, $50.
18        (l) For filing annual statement by a domestic company,
19    except a fraternal benefit society, a mutual benefit
20    association, a burial society, or a farm mutual, $200.
21        (m) For filing annual statement by a domestic
22    fraternal benefit society, $100.
23        (n) For filing annual statement by a farm mutual, a
24    mutual benefit association, or a burial society, $50.
25        (o) For issuing a certificate of authority or renewal
26    thereof except to a foreign fraternal benefit society,

 

 

HB5493- 67 -LRB103 39189 RPS 69335 b

1    $400.
2        (p) For issuing a certificate of authority or renewal
3    thereof to a foreign fraternal benefit society, $200.
4        (q) For issuing an amended certificate of authority,
5    $50.
6        (r) For each certified copy of certificate of
7    authority, $20.
8        (s) For each certificate of deposit, or valuation, or
9    compliance or surety certificate, $20.
10        (t) For copies of papers or records per page, $1.
11        (u) For each certification to copies of papers or
12    records, $10.
13        (v) For multiple copies of documents or certificates
14    listed in subparagraphs (r), (s), and (u) of paragraph (1)
15    of this Section, $10 for the first copy of a certificate of
16    any type and $5 for each additional copy of the same
17    certificate requested at the same time, unless, pursuant
18    to paragraph (2) of this Section, the Director finds these
19    additional fees excessive.
20        (w) For issuing a permit to sell shares or increase
21    paid-up capital:
22            (i) in connection with a public stock offering,
23        $300;
24            (ii) in any other case, $100.
25        (x) For issuing any other certificate required or
26    permissible under the law, $50.

 

 

HB5493- 68 -LRB103 39189 RPS 69335 b

1        (y) For filing a plan of exchange of the stock of a
2    domestic stock insurance company, a plan of
3    demutualization of a domestic mutual company, or a plan of
4    reorganization under Article XII, $2,000.
5        (z) For filing a statement of acquisition of a
6    domestic company as defined in Section 131.4 of this Code,
7    $2,000.
8        (aa) For filing an agreement to purchase the business
9    of an organization authorized under the Dental Service
10    Plan Act or the Voluntary Health Services Plans Act or of a
11    health maintenance organization or a limited health
12    service organization, $2,000.
13        (bb) For filing a statement of acquisition of a
14    foreign or alien insurance company as defined in Section
15    131.12a of this Code, $1,000.
16        (cc) For filing a registration statement as required
17    in Sections 131.13 and 131.14, the notification as
18    required by Sections 131.16, 131.20a, or 141.4, or an
19    agreement or transaction required by Sections 124.2(2),
20    141, 141a, or 141.1, $200.
21        (dd) For filing an application for licensing of:
22            (i) a religious or charitable risk pooling trust
23        or a workers' compensation pool, $1,000;
24            (ii) a workers' compensation service company,
25        $500;
26            (iii) a self-insured automobile fleet, $200; or

 

 

HB5493- 69 -LRB103 39189 RPS 69335 b

1            (iv) a renewal of or amendment of any license
2        issued pursuant to (i), (ii), or (iii) above, $100.
3        (ee) For filing articles of incorporation for a
4    syndicate to engage in the business of insurance through
5    the Illinois Insurance Exchange, $2,000.
6        (ff) For filing amended articles of incorporation for
7    a syndicate engaged in the business of insurance through
8    the Illinois Insurance Exchange, $100.
9        (gg) For filing articles of incorporation for a
10    limited syndicate to join with other subscribers or
11    limited syndicates to do business through the Illinois
12    Insurance Exchange, $1,000.
13        (hh) For filing amended articles of incorporation for
14    a limited syndicate to do business through the Illinois
15    Insurance Exchange, $100.
16        (ii) For a permit to solicit subscriptions to a
17    syndicate or limited syndicate, $100.
18        (jj) For the filing of each form as required in
19    Section 143 of this Code, $50 per form. Informational and
20    advertising filings shall be $25 per filing. The fee for
21    advisory and rating organizations shall be $200 per form.
22            (i) For the purposes of the form filing fee,
23        filings made on insert page basis will be considered
24        one form at the time of its original submission.
25        Changes made to a form subsequent to its approval
26        shall be considered a new filing.

 

 

HB5493- 70 -LRB103 39189 RPS 69335 b

1            (ii) Only one fee shall be charged for a form,
2        regardless of the number of other forms or policies
3        with which it will be used.
4            (iii) Fees charged for a policy filed as it will be
5        issued regardless of the number of forms comprising
6        that policy shall not exceed $1,500. For advisory or
7        rating organizations, fees charged for a policy filed
8        as it will be issued regardless of the number of forms
9        comprising that policy shall not exceed $2,500.
10            (iv) The Director may by rule exempt forms from
11        such fees.
12        (kk) For filing an application for licensing of a
13    reinsurance intermediary, $500.
14        (ll) For filing an application for renewal of a
15    license of a reinsurance intermediary, $200.
16        (mm) For filing a plan of division of a domestic stock
17    company under Article IIB, $100,000 $10,000.
18        (nn) For filing all documents submitted by a foreign
19    or alien company to be a certified reinsurer in this
20    State, except for a fraternal benefit society, $1,000.
21        (oo) For filing a renewal by a foreign or alien
22    company to be a certified reinsurer in this State, except
23    for a fraternal benefit society, $400.
24        (pp) For filing all documents submitted by a reinsurer
25    domiciled in a reciprocal jurisdiction, $1,000.
26        (qq) For filing a renewal by a reinsurer domiciled in

 

 

HB5493- 71 -LRB103 39189 RPS 69335 b

1    a reciprocal jurisdiction, $400.
2        (rr) For registering a captive management company or
3    renewal thereof, $50.
4        (ss) For filing an insurance business transfer plan
5    under Article XLVII, $100,000 $25,000.
6    (2) When printed copies or numerous copies of the same
7paper or records are furnished or certified, the Director may
8reduce such fees for copies if he finds them excessive. He may,
9when he considers it in the public interest, furnish without
10charge to state insurance departments and persons other than
11companies, copies or certified copies of reports of
12examinations and of other papers and records.
13    (3) The expenses incurred in any performance examination
14authorized by law shall be paid by the company or person being
15examined. The charge shall be reasonably related to the cost
16of the examination including but not limited to compensation
17of examiners, electronic data processing costs, supervision
18and preparation of an examination report and lodging and
19travel expenses. All lodging and travel expenses shall be in
20accord with the applicable travel regulations as published by
21the Department of Central Management Services and approved by
22the Governor's Travel Control Board, except that out-of-state
23lodging and travel expenses related to examinations authorized
24under Section 132 shall be in accordance with travel rates
25prescribed under paragraph 301-7.2 of the Federal Travel
26Regulations, 41 CFR C.F.R. 301-7.2, for reimbursement of

 

 

HB5493- 72 -LRB103 39189 RPS 69335 b

1subsistence expenses incurred during official travel. All
2lodging and travel expenses may be reimbursed directly upon
3authorization of the Director. With the exception of the
4direct reimbursements authorized by the Director, all
5performance examination charges collected by the Department
6shall be paid to the Insurance Producer Administration Fund,
7however, the electronic data processing costs incurred by the
8Department in the performance of any examination shall be
9billed directly to the company being examined for payment to
10the Technology Management Revolving Fund.
11    (4) At the time of any service of process on the Director
12as attorney for such service, the Director shall charge and
13collect the sum of $40, which may be recovered as taxable costs
14by the party to the suit or action causing such service to be
15made if he prevails in such suit or action.
16    (5) (a) The costs incurred by the Department of Insurance
17in conducting any hearing authorized by law shall be assessed
18against the parties to the hearing in such proportion as the
19Director of Insurance may determine upon consideration of all
20relevant circumstances including: (1) the nature of the
21hearing; (2) whether the hearing was instigated by, or for the
22benefit of a particular party or parties; (3) whether there is
23a successful party on the merits of the proceeding; and (4) the
24relative levels of participation by the parties.
25    (b) For purposes of this subsection (5) costs incurred
26shall mean the hearing officer fees, court reporter fees, and

 

 

HB5493- 73 -LRB103 39189 RPS 69335 b

1travel expenses of Department of Insurance officers and
2employees; provided however, that costs incurred shall not
3include hearing officer fees or court reporter fees unless the
4Department has retained the services of independent
5contractors or outside experts to perform such functions.
6    (c) The Director shall make the assessment of costs
7incurred as part of the final order or decision arising out of
8the proceeding; provided, however, that such order or decision
9shall include findings and conclusions in support of the
10assessment of costs. This subsection (5) shall not be
11construed as permitting the payment of travel expenses unless
12calculated in accordance with the applicable travel
13regulations of the Department of Central Management Services,
14as approved by the Governor's Travel Control Board. The
15Director as part of such order or decision shall require all
16assessments for hearing officer fees and court reporter fees,
17if any, to be paid directly to the hearing officer or court
18reporter by the party(s) assessed for such costs. The
19assessments for travel expenses of Department officers and
20employees shall be reimbursable to the Director of Insurance
21for deposit to the fund out of which those expenses had been
22paid.
23    (d) The provisions of this subsection (5) shall apply in
24the case of any hearing conducted by the Director of Insurance
25not otherwise specifically provided for by law.
26    (6) The Director shall charge and collect an annual

 

 

HB5493- 74 -LRB103 39189 RPS 69335 b

1financial regulation fee from every domestic company for
2examination and analysis of its financial condition and to
3fund the internal costs and expenses of the Interstate
4Insurance Receivership Commission as may be allocated to the
5State of Illinois and companies doing an insurance business in
6this State pursuant to Article X of the Interstate Insurance
7Receivership Compact. The fee shall be the greater fixed
8amount based upon the combination of nationwide direct premium
9income and nationwide reinsurance assumed premium income or
10upon admitted assets calculated under this subsection as
11follows:
12        (a) Combination of nationwide direct premium income
13    and nationwide reinsurance assumed premium.
14            (i) $150, if the premium is less than $500,000 and
15        there is no reinsurance assumed premium;
16            (ii) $750, if the premium is $500,000 or more, but
17        less than $5,000,000 and there is no reinsurance
18        assumed premium; or if the premium is less than
19        $5,000,000 and the reinsurance assumed premium is less
20        than $10,000,000;
21            (iii) $3,750, if the premium is less than
22        $5,000,000 and the reinsurance assumed premium is
23        $10,000,000 or more;
24            (iv) $7,500, if the premium is $5,000,000 or more,
25        but less than $10,000,000;
26            (v) $18,000, if the premium is $10,000,000 or

 

 

HB5493- 75 -LRB103 39189 RPS 69335 b

1        more, but less than $25,000,000;
2            (vi) $22,500, if the premium is $25,000,000 or
3        more, but less than $50,000,000;
4            (vii) $30,000, if the premium is $50,000,000 or
5        more, but less than $100,000,000;
6            (viii) $37,500, if the premium is $100,000,000 or
7        more.
8        (b) Admitted assets.
9            (i) $150, if admitted assets are less than
10        $1,000,000;
11            (ii) $750, if admitted assets are $1,000,000 or
12        more, but less than $5,000,000;
13            (iii) $3,750, if admitted assets are $5,000,000 or
14        more, but less than $25,000,000;
15            (iv) $7,500, if admitted assets are $25,000,000 or
16        more, but less than $50,000,000;
17            (v) $18,000, if admitted assets are $50,000,000 or
18        more, but less than $100,000,000;
19            (vi) $22,500, if admitted assets are $100,000,000
20        or more, but less than $500,000,000;
21            (vii) $30,000, if admitted assets are $500,000,000
22        or more, but less than $1,000,000,000;
23            (viii) $37,500, if admitted assets are
24        $1,000,000,000 or more.
25        (c) The sum of financial regulation fees charged to
26    the domestic companies of the same affiliated group shall

 

 

HB5493- 76 -LRB103 39189 RPS 69335 b

1    not exceed $250,000 in the aggregate in any single year
2    and shall be billed by the Director to the member company
3    designated by the group.
4    (7) The Director shall charge and collect an annual
5financial regulation fee from every foreign or alien company,
6except fraternal benefit societies, for the examination and
7analysis of its financial condition and to fund the internal
8costs and expenses of the Interstate Insurance Receivership
9Commission as may be allocated to the State of Illinois and
10companies doing an insurance business in this State pursuant
11to Article X of the Interstate Insurance Receivership Compact.
12The fee shall be a fixed amount based upon Illinois direct
13premium income and nationwide reinsurance assumed premium
14income in accordance with the following schedule:
15        (a) $150, if the premium is less than $500,000 and
16    there is no reinsurance assumed premium;
17        (b) $750, if the premium is $500,000 or more, but less
18    than $5,000,000 and there is no reinsurance assumed
19    premium; or if the premium is less than $5,000,000 and the
20    reinsurance assumed premium is less than $10,000,000;
21        (c) $3,750, if the premium is less than $5,000,000 and
22    the reinsurance assumed premium is $10,000,000 or more;
23        (d) $7,500, if the premium is $5,000,000 or more, but
24    less than $10,000,000;
25        (e) $18,000, if the premium is $10,000,000 or more,
26    but less than $25,000,000;

 

 

HB5493- 77 -LRB103 39189 RPS 69335 b

1        (f) $22,500, if the premium is $25,000,000 or more,
2    but less than $50,000,000;
3        (g) $30,000, if the premium is $50,000,000 or more,
4    but less than $100,000,000;
5        (h) $37,500, if the premium is $100,000,000 or more.
6    The sum of financial regulation fees under this subsection
7(7) charged to the foreign or alien companies within the same
8affiliated group shall not exceed $250,000 in the aggregate in
9any single year and shall be billed by the Director to the
10member company designated by the group.
11    (8) Beginning January 1, 1992, the financial regulation
12fees imposed under subsections (6) and (7) of this Section
13shall be paid by each company or domestic affiliated group
14annually. After January 1, 1994, the fee shall be billed by
15Department invoice based upon the company's premium income or
16admitted assets as shown in its annual statement for the
17preceding calendar year. The invoice is due upon receipt and
18must be paid no later than June 30 of each calendar year. All
19financial regulation fees collected by the Department shall be
20paid to the Insurance Financial Regulation Fund. The
21Department may not collect financial examiner per diem charges
22from companies subject to subsections (6) and (7) of this
23Section undergoing financial examination after June 30, 1992.
24    (9) In addition to the financial regulation fee required
25by this Section, a company undergoing any financial
26examination authorized by law shall pay the following costs

 

 

HB5493- 78 -LRB103 39189 RPS 69335 b

1and expenses incurred by the Department: electronic data
2processing costs, the expenses authorized under Section 131.21
3and subsection (d) of Section 132.4 of this Code, and lodging
4and travel expenses.
5    Electronic data processing costs incurred by the
6Department in the performance of any examination shall be
7billed directly to the company undergoing examination for
8payment to the Technology Management Revolving Fund. Except
9for direct reimbursements authorized by the Director or direct
10payments made under Section 131.21 or subsection (d) of
11Section 132.4 of this Code, all financial regulation fees and
12all financial examination charges collected by the Department
13shall be paid to the Insurance Financial Regulation Fund.
14    All lodging and travel expenses shall be in accordance
15with applicable travel regulations published by the Department
16of Central Management Services and approved by the Governor's
17Travel Control Board, except that out-of-state lodging and
18travel expenses related to examinations authorized under
19Sections 132.1 through 132.7 shall be in accordance with
20travel rates prescribed under paragraph 301-7.2 of the Federal
21Travel Regulations, 41 CFR C.F.R. 301-7.2, for reimbursement
22of subsistence expenses incurred during official travel. All
23lodging and travel expenses may be reimbursed directly upon
24the authorization of the Director.
25    In the case of an organization or person not subject to the
26financial regulation fee, the expenses incurred in any

 

 

HB5493- 79 -LRB103 39189 RPS 69335 b

1financial examination authorized by law shall be paid by the
2organization or person being examined. The charge shall be
3reasonably related to the cost of the examination including,
4but not limited to, compensation of examiners and other costs
5described in this subsection.
6    (10) Any company, person, or entity failing to make any
7payment of $150 or more as required under this Section shall be
8subject to the penalty and interest provisions provided for in
9subsections (4) and (7) of Section 412.
10    (11) Unless otherwise specified, all of the fees collected
11under this Section shall be paid into the Insurance Financial
12Regulation Fund.
13    (12) For purposes of this Section:
14        (a) "Domestic company" means a company as defined in
15    Section 2 of this Code which is incorporated or organized
16    under the laws of this State, and in addition includes a
17    not-for-profit corporation authorized under the Dental
18    Service Plan Act or the Voluntary Health Services Plans
19    Act, a health maintenance organization, and a limited
20    health service organization.
21        (b) "Foreign company" means a company as defined in
22    Section 2 of this Code which is incorporated or organized
23    under the laws of any state of the United States other than
24    this State and in addition includes a health maintenance
25    organization and a limited health service organization
26    which is incorporated or organized under the laws of any

 

 

HB5493- 80 -LRB103 39189 RPS 69335 b

1    state of the United States other than this State.
2        (c) "Alien company" means a company as defined in
3    Section 2 of this Code which is incorporated or organized
4    under the laws of any country other than the United
5    States.
6        (d) "Fraternal benefit society" means a corporation,
7    society, order, lodge or voluntary association as defined
8    in Section 282.1 of this Code.
9        (e) "Mutual benefit association" means a company,
10    association or corporation authorized by the Director to
11    do business in this State under the provisions of Article
12    XVIII of this Code.
13        (f) "Burial society" means a person, firm,
14    corporation, society or association of individuals
15    authorized by the Director to do business in this State
16    under the provisions of Article XIX of this Code.
17        (g) "Farm mutual" means a district, county and
18    township mutual insurance company authorized by the
19    Director to do business in this State under the provisions
20    of the Farm Mutual Insurance Company Act of 1986.
21(Source: P.A. 102-775, eff. 5-13-22; 103-75, eff. 1-1-25.)
 
22    (215 ILCS 5/412)  (from Ch. 73, par. 1024)
23    Sec. 412. Refunds; penalties; collection.
24    (1)(a) Whenever it appears to the satisfaction of the
25Director that because of some mistake of fact, error in

 

 

HB5493- 81 -LRB103 39189 RPS 69335 b

1calculation, or erroneous interpretation of a statute of this
2or any other state, any authorized company, surplus line
3producer, or industrial insured has paid to him, pursuant to
4any provision of law, taxes, fees, or other charges in excess
5of the amount legally chargeable against it, during the 6-year
66 year period immediately preceding the discovery of such
7overpayment, he shall have power to refund to such company,
8surplus line producer, or industrial insured the amount of the
9excess or excesses by applying the amount or amounts thereof
10toward the payment of taxes, fees, or other charges already
11due, or which may thereafter become due from that company
12until such excess or excesses have been fully refunded, or
13upon a written request from the authorized company, surplus
14line producer, or industrial insured, the Director shall
15provide a cash refund within 120 days after receipt of the
16written request if all necessary information has been filed
17with the Department in order for it to perform an audit of the
18tax report for the transaction or period or annual return for
19the year in which the overpayment occurred or within 120 days
20after the date the Department receives all the necessary
21information to perform such audit. The Director shall not
22provide a cash refund if there are insufficient funds in the
23Insurance Premium Tax Refund Fund to provide a cash refund, if
24the amount of the overpayment is less than $100, or if the
25amount of the overpayment can be fully offset against the
26taxpayer's estimated liability for the year following the year

 

 

HB5493- 82 -LRB103 39189 RPS 69335 b

1of the cash refund request. Any cash refund shall be paid from
2the Insurance Premium Tax Refund Fund, a special fund hereby
3created in the State treasury.
4    (b) As determined by the Director pursuant to paragraph
5(a) of this subsection, the Department shall deposit an amount
6of cash refunds approved by the Director for payment as a
7result of overpayment of tax liability collected under
8Sections 121-2.08, 409, 444, 444.1, and 445 of this Code into
9the Insurance Premium Tax Refund Fund.
10    (c) Beginning July 1, 1999, moneys in the Insurance
11Premium Tax Refund Fund shall be expended exclusively for the
12purpose of paying cash refunds resulting from overpayment of
13tax liability under Sections 121-2.08, 409, 444, 444.1, and
14445 of this Code as determined by the Director pursuant to
15subsection 1(a) of this Section. Cash refunds made in
16accordance with this Section may be made from the Insurance
17Premium Tax Refund Fund only to the extent that amounts have
18been deposited and retained in the Insurance Premium Tax
19Refund Fund.
20    (d) This Section shall constitute an irrevocable and
21continuing appropriation from the Insurance Premium Tax Refund
22Fund for the purpose of paying cash refunds pursuant to the
23provisions of this Section.
24    (2)(a) When any insurance company fails to file any tax
25return required under Sections 408.1, 409, 444, and 444.1 of
26this Code or Section 12 of the Fire Investigation Act on the

 

 

HB5493- 83 -LRB103 39189 RPS 69335 b

1date prescribed, including any extensions, there shall be
2added as a penalty $400 or 10% of the amount of such tax,
3whichever is greater, for each month or part of a month of
4failure to file, the entire penalty not to exceed $2,000 or 50%
5of the tax due, whichever is greater. In this paragraph, "tax
6due" means the full amount due for that year under Section
7408.1, 409, 444, or 444.1 of this Code or Section 12 of the
8Fire Investigation Act.
9    (b) When any industrial insured or surplus line producer
10fails to file any tax return or report required under Sections
11121-2.08 and 445 of this Code or Section 12 of the Fire
12Investigation Act on the date prescribed, including any
13extensions, there shall be added:
14        (i) as a late fee, if the return or report is received
15    at least one day but not more than 15 days after the
16    prescribed due date, $50 or 5% of the tax due, whichever is
17    greater, the entire fee not to exceed $1,000;
18        (ii) as a late fee, if the return or report is received
19    at least 16 days but not more than 30 days after the
20    prescribed due date, $100 or 5% of the tax due, whichever
21    is greater, the entire fee not to exceed $2,000; or
22        (iii) as a penalty, if the return or report is
23    received more than 30 days after the prescribed due date,
24    $100 or 5% of the tax due, whichever is greater, for each
25    month or part of a month of failure to file, the entire
26    penalty not to exceed $500 or 30% of the tax due, whichever

 

 

HB5493- 84 -LRB103 39189 RPS 69335 b

1    is greater.
2    In this paragraph, "tax due" means the full amount due for
3that year under Section 121-2.08 or 445 of this Code or Section
412 of the Fire Investigation Act. A tax return or report shall
5be deemed received as of the date mailed as evidenced by a
6postmark, proof of mailing on a
recognized United States
7Postal Service form or a form acceptable to the United States
8Postal Service or other commercial mail delivery service, or
9other evidence acceptable to the Director.
10    (3)(a) When any insurance company fails to pay the full
11amount due under the provisions of this Section, Sections
12408.1, 409, 444, or 444.1 of this Code, or Section 12 of the
13Fire Investigation Act, there shall be added to the amount due
14as a penalty an amount equal to 10% of the deficiency.
15    (a-5) When any industrial insured or surplus line producer
16fails to pay the full amount due under the provisions of this
17Section, Sections 121-2.08 or 445 of this Code, or Section 12
18of the Fire Investigation Act on the date prescribed, there
19shall be added:
20        (i) as a late fee, if the payment is received at least
21    one day but not more than 7 days after the prescribed due
22    date, 10% of the tax due, the entire fee not to exceed
23    $1,000;
24        (ii) as a late fee, if the payment is received at least
25    8 days but not more than 14 days after the prescribed due
26    date, 10% of the tax due, the entire fee not to exceed

 

 

HB5493- 85 -LRB103 39189 RPS 69335 b

1    $1,500;
2        (iii) as a late fee, if the payment is received at
3    least 15 days but not more than 21 days after the
4    prescribed due date, 10% of the tax due, the entire fee not
5    to exceed $2,000; or
6        (iv) as a penalty, if the return or report is received
7    more than 21 days after the prescribed due date, 10% of the
8    tax due.
9    In this paragraph, "tax due" means the full amount due for
10that year under this Section, Section 121-2.08 or 445 of this
11Code, or Section 12 of the Fire Investigation Act. A tax
12payment shall be deemed received as of the date mailed as
13evidenced by a postmark, proof of mailing on a recognized
14United States Postal Service form or a form acceptable to the
15United States Postal Service or other commercial mail delivery
16service, or other evidence acceptable to the Director.
17    (b) If such failure to pay is determined by the Director to
18be willful wilful, after a hearing under Sections 402 and 403,
19there shall be added to the tax as a penalty an amount equal to
20the greater of 50% of the deficiency or 10% of the amount due
21and unpaid for each month or part of a month that the
22deficiency remains unpaid commencing with the date that the
23amount becomes due. Such amount shall be in lieu of any
24determined under paragraph (a) or (a-5).
25    (4) Any insurance company, industrial insured, or surplus
26line producer that fails to pay the full amount due under this

 

 

HB5493- 86 -LRB103 39189 RPS 69335 b

1Section or Sections 121-2.08, 408.1, 409, 444, 444.1, or 445
2of this Code, or Section 12 of the Fire Investigation Act is
3liable, in addition to the tax and any late fees and penalties,
4for interest on such deficiency at the rate of 12% per annum,
5or at such higher adjusted rates as are or may be established
6under subsection (b) of Section 6621 of the Internal Revenue
7Code, from the date that payment of any such tax was due,
8determined without regard to any extensions, to the date of
9payment of such amount.
10    (5) The Director, through the Attorney General, may
11institute an action in the name of the People of the State of
12Illinois, in any court of competent jurisdiction, for the
13recovery of the amount of such taxes, fees, and penalties due,
14and prosecute the same to final judgment, and take such steps
15as are necessary to collect the same.
16    (6) In the event that the certificate of authority of a
17foreign or alien company is revoked for any cause or the
18company withdraws from this State prior to the renewal date of
19the certificate of authority as provided in Section 114, the
20company may recover the amount of any such tax paid in advance.
21Except as provided in this subsection, no revocation or
22withdrawal excuses payment of or constitutes grounds for the
23recovery of any taxes or penalties imposed by this Code.
24    (7) When an insurance company or domestic affiliated group
25fails to pay the full amount of any fee of $200 or more due
26under Section 408 of this Code, there shall be added to the

 

 

HB5493- 87 -LRB103 39189 RPS 69335 b

1amount due as a penalty the greater of $100 or an amount equal
2to 10% of the deficiency for each month or part of a month that
3the deficiency remains unpaid.
4    (8) The Department shall have a lien for the taxes, fees,
5charges, fines, penalties, interest, other charges, or any
6portion thereof, imposed or assessed pursuant to this Code,
7upon all the real and personal property of any company or
8person to whom the assessment or final order has been issued or
9whenever a tax return is filed without payment of the tax or
10penalty shown therein to be due, including all such property
11of the company or person acquired after receipt of the
12assessment, issuance of the order, or filing of the return.
13The company or person is liable for the filing fee incurred by
14the Department for filing the lien and the filing fee incurred
15by the Department to file the release of that lien. The filing
16fees shall be paid to the Department in addition to payment of
17the tax, fee, charge, fine, penalty, interest, other charges,
18or any portion thereof, included in the amount of the lien.
19However, where the lien arises because of the issuance of a
20final order of the Director or tax assessment by the
21Department, the lien shall not attach and the notice referred
22to in this Section shall not be filed until all administrative
23proceedings or proceedings in court for review of the final
24order or assessment have terminated or the time for the taking
25thereof has expired without such proceedings being instituted.
26    Upon the granting of Department review after a lien has

 

 

HB5493- 88 -LRB103 39189 RPS 69335 b

1attached, the lien shall remain in full force except to the
2extent to which the final assessment may be reduced by a
3revised final assessment following the rehearing or review.
4The lien created by the issuance of a final assessment shall
5terminate, unless a notice of lien is filed, within 3 years
6after the date all proceedings in court for the review of the
7final assessment have terminated or the time for the taking
8thereof has expired without such proceedings being instituted,
9or (in the case of a revised final assessment issued pursuant
10to a rehearing or review by the Department) within 3 years
11after the date all proceedings in court for the review of such
12revised final assessment have terminated or the time for the
13taking thereof has expired without such proceedings being
14instituted. Where the lien results from the filing of a tax
15return without payment of the tax or penalty shown therein to
16be due, the lien shall terminate, unless a notice of lien is
17filed, within 3 years after the date when the return is filed
18with the Department.
19    The time limitation period on the Department's right to
20file a notice of lien shall not run during any period of time
21in which the order of any court has the effect of enjoining or
22restraining the Department from filing such notice of lien. If
23the Department finds that a company or person is about to
24depart from the State, to conceal himself or his property, or
25to do any other act tending to prejudice or to render wholly or
26partly ineffectual proceedings to collect the amount due and

 

 

HB5493- 89 -LRB103 39189 RPS 69335 b

1owing to the Department unless such proceedings are brought
2without delay, or if the Department finds that the collection
3of the amount due from any company or person will be
4jeopardized by delay, the Department shall give the company or
5person notice of such findings and shall make demand for
6immediate return and payment of the amount, whereupon the
7amount shall become immediately due and payable. If the
8company or person, within 5 days after the notice (or within
9such extension of time as the Department may grant), does not
10comply with the notice or show to the Department that the
11findings in the notice are erroneous, the Department may file
12a notice of jeopardy assessment lien in the office of the
13recorder of the county in which any property of the company or
14person may be located and shall notify the company or person of
15the filing. The jeopardy assessment lien shall have the same
16scope and effect as the statutory lien provided for in this
17Section. If the company or person believes that the company or
18person does not owe some or all of the tax for which the
19jeopardy assessment lien against the company or person has
20been filed, or that no jeopardy to the revenue in fact exists,
21the company or person may protest within 20 days after being
22notified by the Department of the filing of the jeopardy
23assessment lien and request a hearing, whereupon the
24Department shall hold a hearing in conformity with the
25provisions of this Code and, pursuant thereto, shall notify
26the company or person of its findings as to whether or not the

 

 

HB5493- 90 -LRB103 39189 RPS 69335 b

1jeopardy assessment lien will be released. If not, and if the
2company or person is aggrieved by this decision, the company
3or person may file an action for judicial review of the final
4determination of the Department in accordance with the
5Administrative Review Law. If, pursuant to such hearing (or
6after an independent determination of the facts by the
7Department without a hearing), the Department determines that
8some or all of the amount due covered by the jeopardy
9assessment lien is not owed by the company or person, or that
10no jeopardy to the revenue exists, or if on judicial review the
11final judgment of the court is that the company or person does
12not owe some or all of the amount due covered by the jeopardy
13assessment lien against them, or that no jeopardy to the
14revenue exists, the Department shall release its jeopardy
15assessment lien to the extent of such finding of nonliability
16for the amount, or to the extent of such finding of no jeopardy
17to the revenue. The Department shall also release its jeopardy
18assessment lien against the company or person whenever the
19amount due and owing covered by the lien, plus any interest
20which may be due, are paid and the company or person has paid
21the Department in cash or by guaranteed remittance an amount
22representing the filing fee for the lien and the filing fee for
23the release of that lien. The Department shall file that
24release of lien with the recorder of the county where that lien
25was filed.
26    Nothing in this Section shall be construed to give the

 

 

HB5493- 91 -LRB103 39189 RPS 69335 b

1Department a preference over the rights of any bona fide
2purchaser, holder of a security interest, mechanics
3lienholder, mortgagee, or judgment lien creditor arising prior
4to the filing of a regular notice of lien or a notice of
5jeopardy assessment lien in the office of the recorder in the
6county in which the property subject to the lien is located.
7For purposes of this Section, "bona fide" shall not include
8any mortgage of real or personal property or any other credit
9transaction that results in the mortgagee or the holder of the
10security acting as trustee for unsecured creditors of the
11company or person mentioned in the notice of lien who executed
12such chattel or real property mortgage or the document
13evidencing such credit transaction. The lien shall be inferior
14to the lien of general taxes, special assessments, and special
15taxes levied by any political subdivision of this State. In
16case title to land to be affected by the notice of lien or
17notice of jeopardy assessment lien is registered under the
18provisions of the Registered Titles (Torrens) Act, such notice
19shall be filed in the office of the Registrar of Titles of the
20county within which the property subject to the lien is
21situated and shall be entered upon the register of titles as a
22memorial or charge upon each folium of the register of titles
23affected by such notice, and the Department shall not have a
24preference over the rights of any bona fide purchaser,
25mortgagee, judgment creditor, or other lienholder arising
26prior to the registration of such notice. The regular lien or

 

 

HB5493- 92 -LRB103 39189 RPS 69335 b

1jeopardy assessment lien shall not be effective against any
2purchaser with respect to any item in a retailer's stock in
3trade purchased from the retailer in the usual course of the
4retailer's business.
5(Source: P.A. 102-775, eff. 5-13-22; 103-426, eff. 8-4-23.)
 
6    (215 ILCS 5/531.03)  (from Ch. 73, par. 1065.80-3)
7    Sec. 531.03. Coverage and limitations.
8    (1) This Article shall provide coverage for the policies
9and contracts specified in subsection (2) of this Section:
10        (a) to persons who, regardless of where they reside
11    (except for non-resident certificate holders under group
12    policies or contracts), are the beneficiaries, assignees
13    or payees, including health care providers rendering
14    services covered under a health insurance policy or
15    certificate, of the persons covered under paragraph (b) of
16    this subsection, and
17        (b) to persons who are owners of or certificate
18    holders or enrollees under the policies or contracts
19    (other than unallocated annuity contracts and structured
20    settlement annuities) and in each case who:
21            (i) are residents; or
22            (ii) are not residents, but only under all of the
23        following conditions:
24                (A) the member insurer that issued the
25            policies or contracts is domiciled in this State;

 

 

HB5493- 93 -LRB103 39189 RPS 69335 b

1                (B) the states in which the persons reside
2            have associations similar to the Association
3            created by this Article;
4                (C) the persons are not eligible for coverage
5            by an association in any other state due to the
6            fact that the insurer or health maintenance
7            organization was not licensed in that state at the
8            time specified in that state's guaranty
9            association law.
10        (c) For unallocated annuity contracts specified in
11    subsection (2), paragraphs (a) and (b) of this subsection
12    (1) shall not apply and this Article shall (except as
13    provided in paragraphs (e) and (f) of this subsection)
14    provide coverage to:
15            (i) persons who are the owners of the unallocated
16        annuity contracts if the contracts are issued to or in
17        connection with a specific benefit plan whose plan
18        sponsor has its principal place of business in this
19        State; and
20            (ii) persons who are owners of unallocated annuity
21        contracts issued to or in connection with government
22        lotteries if the owners are residents.
23        (d) For structured settlement annuities specified in
24    subsection (2), paragraphs (a) and (b) of this subsection
25    (1) shall not apply and this Article shall (except as
26    provided in paragraphs (e) and (f) of this subsection)

 

 

HB5493- 94 -LRB103 39189 RPS 69335 b

1    provide coverage to a person who is a payee under a
2    structured settlement annuity (or beneficiary of a payee
3    if the payee is deceased), if the payee:
4            (i) is a resident, regardless of where the
5        contract owner resides; or
6            (ii) is not a resident, but only under both of the
7        following conditions:
8                (A) with regard to residency:
9                    (I) the contract owner of the structured
10                settlement annuity is a resident; or
11                    (II) the contract owner of the structured
12                settlement annuity is not a resident but the
13                insurer that issued the structured settlement
14                annuity is domiciled in this State and the
15                state in which the contract owner resides has
16                an association similar to the Association
17                created by this Article; and
18                (B) neither the payee or beneficiary nor the
19            contract owner is eligible for coverage by the
20            association of the state in which the payee or
21            contract owner resides.
22        (e) This Article shall not provide coverage to:
23            (i) a person who is a payee or beneficiary of a
24        contract owner resident of this State if the payee or
25        beneficiary is afforded any coverage by the
26        association of another state; or

 

 

HB5493- 95 -LRB103 39189 RPS 69335 b

1            (ii) a person covered under paragraph (c) of this
2        subsection (1), if any coverage is provided by the
3        association of another state to that person.
4        (f) This Article is intended to provide coverage to a
5    person who is a resident of this State and, in special
6    circumstances, to a nonresident. In order to avoid
7    duplicate coverage, if a person who would otherwise
8    receive coverage under this Article is provided coverage
9    under the laws of any other state, then the person shall
10    not be provided coverage under this Article. In
11    determining the application of the provisions of this
12    paragraph in situations where a person could be covered by
13    the association of more than one state, whether as an
14    owner, payee, enrollee, beneficiary, or assignee, this
15    Article shall be construed in conjunction with other state
16    laws to result in coverage by only one association.
17    (2)(a) This Article shall provide coverage to the persons
18specified in subsection (1) of this Section for policies or
19contracts of direct, (i) nongroup life insurance, health
20insurance (that, for the purposes of this Article, includes
21health maintenance organization subscriber contracts and
22certificates), annuities and supplemental contracts to any of
23these, (ii) for certificates under direct group policies or
24contracts, (iii) for unallocated annuity contracts and (iv)
25for contracts to furnish health care services and subscription
26certificates for medical or health care services issued by

 

 

HB5493- 96 -LRB103 39189 RPS 69335 b

1persons licensed to transact insurance business in this State
2under this Code. Annuity contracts and certificates under
3group annuity contracts include but are not limited to
4guaranteed investment contracts, deposit administration
5contracts, unallocated funding agreements, allocated funding
6agreements, structured settlement agreements, lottery
7contracts and any immediate or deferred annuity contracts.
8    (b) Except as otherwise provided in paragraph (c) of this
9subsection, this Article shall not provide coverage for:
10        (i) that portion of a policy or contract not
11    guaranteed by the member insurer, or under which the risk
12    is borne by the policy or contract owner;
13        (ii) any such policy or contract or part thereof
14    assumed by the impaired or insolvent insurer under a
15    contract of reinsurance, other than reinsurance for which
16    assumption certificates have been issued;
17        (iii) any portion of a policy or contract to the
18    extent that the rate of interest on which it is based or
19    the interest rate, crediting rate, or similar factor is
20    determined by use of an index or other external reference
21    stated in the policy or contract employed in calculating
22    returns or changes in value:
23            (A) averaged over the period of 4 years prior to
24        the date on which the member insurer becomes an
25        impaired or insolvent insurer under this Article,
26        whichever is earlier, exceeds the rate of interest

 

 

HB5493- 97 -LRB103 39189 RPS 69335 b

1        determined by subtracting 2 percentage points from
2        Moody's Corporate Bond Yield Average averaged for that
3        same 4-year period or for such lesser period if the
4        policy or contract was issued less than 4 years before
5        the member insurer becomes an impaired or insolvent
6        insurer under this Article, whichever is earlier; and
7            (B) on and after the date on which the member
8        insurer becomes an impaired or insolvent insurer under
9        this Article, whichever is earlier, exceeds the rate
10        of interest determined by subtracting 3 percentage
11        points from Moody's Corporate Bond Yield Average as
12        most recently available;
13        (iv) any unallocated annuity contract issued to or in
14    connection with a benefit plan protected under the federal
15    Pension Benefit Guaranty Corporation, regardless of
16    whether the federal Pension Benefit Guaranty Corporation
17    has yet become liable to make any payments with respect to
18    the benefit plan;
19        (v) any portion of any unallocated annuity contract
20    which is not issued to or in connection with a specific
21    employee, union or association of natural persons benefit
22    plan or a government lottery;
23        (vi) an obligation that does not arise under the
24    express written terms of the policy or contract issued by
25    the member insurer to the enrollee, certificate holder,
26    contract owner, or policy owner, including without

 

 

HB5493- 98 -LRB103 39189 RPS 69335 b

1    limitation:
2            (A) a claim based on marketing materials;
3            (B) a claim based on side letters, riders, or
4        other documents that were issued by the member insurer
5        without meeting applicable policy or contract form
6        filing or approval requirements;
7            (C) a misrepresentation of or regarding policy or
8        contract benefits;
9            (D) an extra-contractual claim; or
10            (E) a claim for penalties or consequential or
11        incidental damages;
12        (vii) any stop-loss insurance, as defined in clause
13    (b) of Class 1 or clause (a) of Class 2 of Section 4, and
14    further defined in subsection (d) of Section 352;
15        (viii) any policy or contract providing any hospital,
16    medical, prescription drug, or other health care benefits
17    pursuant to Part C or Part D of Subchapter XVIII, Chapter 7
18    of Title 42 of the United States Code (commonly known as
19    Medicare Part C & D), Subchapter XIX, Chapter 7 of Title 42
20    of the United States Code (commonly known as Medicaid), or
21    any regulations issued pursuant thereto;
22        (ix) any portion of a policy or contract to the extent
23    that the assessments required by Section 531.09 of this
24    Code with respect to the policy or contract are preempted
25    or otherwise not permitted by federal or State law;
26        (x) any portion of a policy or contract issued to a

 

 

HB5493- 99 -LRB103 39189 RPS 69335 b

1    plan or program of an employer, association, or other
2    person to provide life, health, or annuity benefits to its
3    employees, members, or others to the extent that the plan
4    or program is self-funded or uninsured, including, but not
5    limited to, benefits payable by an employer, association,
6    or other person under:
7            (A) a multiple employer welfare arrangement as
8        defined in 29 U.S.C. Section 1002;
9            (B) a minimum premium group insurance plan;
10            (C) a stop-loss group insurance plan; or
11            (D) an administrative services only contract;
12        (xi) any portion of a policy or contract to the extent
13    that it provides for:
14            (A) dividends or experience rating credits;
15            (B) voting rights; or
16            (C) payment of any fees or allowances to any
17        person, including the policy or contract owner, in
18        connection with the service to or administration of
19        the policy or contract;
20        (xii) any policy or contract issued in this State by a
21    member insurer at a time when it was not licensed or did
22    not have a certificate of authority to issue the policy or
23    contract in this State;
24        (xiii) any contractual agreement that establishes the
25    member insurer's obligations to provide a book value
26    accounting guaranty for defined contribution benefit plan

 

 

HB5493- 100 -LRB103 39189 RPS 69335 b

1    participants by reference to a portfolio of assets that is
2    owned by the benefit plan or its trustee, which in each
3    case is not an affiliate of the member insurer;
4        (xiv) any portion of a policy or contract to the
5    extent that it provides for interest or other changes in
6    value to be determined by the use of an index or other
7    external reference stated in the policy or contract, but
8    which have not been credited to the policy or contract, or
9    as to which the policy or contract owner's rights are
10    subject to forfeiture, as of the date the member insurer
11    becomes an impaired or insolvent insurer under this Code,
12    whichever is earlier. If a policy's or contract's interest
13    or changes in value are credited less frequently than
14    annually, then for purposes of determining the values that
15    have been credited and are not subject to forfeiture under
16    this Section, the interest or change in value determined
17    by using the procedures defined in the policy or contract
18    will be credited as if the contractual date of crediting
19    interest or changing values was the date of impairment or
20    insolvency, whichever is earlier, and will not be subject
21    to forfeiture; or
22        (xv) that portion or part of a variable life insurance
23    or variable annuity contract not guaranteed by a member
24    insurer.
25    (c) The exclusion from coverage referenced in subdivision
26(iii) of paragraph (b) of this subsection shall not apply to

 

 

HB5493- 101 -LRB103 39189 RPS 69335 b

1any portion of a policy or contract, including a rider, that
2provides long-term care or other health insurance benefits.
3    (3) The benefits for which the Association may become
4liable shall in no event exceed the lesser of:
5        (a) the contractual obligations for which the member
6    insurer is liable or would have been liable if it were not
7    an impaired or insolvent insurer, or
8        (b)(i) with respect to any one life, regardless of the
9    number of policies or contracts:
10            (A) $300,000 in life insurance death benefits, but
11        not more than $100,000 in net cash surrender and net
12        cash withdrawal values for life insurance;
13            (B) for health insurance benefits:
14                (I) $100,000 for coverages not defined as
15            disability income insurance or health benefit
16            plans or long-term care insurance, including any
17            net cash surrender and net cash withdrawal values;
18                (II) $300,000 for disability income insurance
19            and $300,000 for long-term care insurance; and
20                (III) $500,000 for health benefit plans;
21            (C) $250,000 in the present value of annuity
22        benefits, including net cash surrender and net cash
23        withdrawal values;
24        (ii) with respect to each individual participating in
25    a governmental retirement benefit plan established under
26    Section 401, 403(b), or 457 of the U.S. Internal Revenue

 

 

HB5493- 102 -LRB103 39189 RPS 69335 b

1    Code covered by an unallocated annuity contract or the
2    beneficiaries of each such individual if deceased, in the
3    aggregate, $250,000 in present value annuity benefits,
4    including net cash surrender and net cash withdrawal
5    values;
6        (iii) with respect to each payee of a structured
7    settlement annuity or beneficiary or beneficiaries of the
8    payee if deceased, $250,000 in present value annuity
9    benefits, in the aggregate, including net cash surrender
10    and net cash withdrawal values, if any; or
11        (iv) with respect to either (1) one contract owner
12    provided coverage under subparagraph (ii) of paragraph (c)
13    of subsection (1) of this Section or (2) one plan sponsor
14    whose plans own directly or in trust one or more
15    unallocated annuity contracts not included in subparagraph
16    (ii) of paragraph (b) of this subsection, $5,000,000 in
17    benefits, irrespective of the number of contracts with
18    respect to the contract owner or plan sponsor. However, in
19    the case where one or more unallocated annuity contracts
20    are covered contracts under this Article and are owned by
21    a trust or other entity for the benefit of 2 or more plan
22    sponsors, coverage shall be afforded by the Association if
23    the largest interest in the trust or entity owning the
24    contract or contracts is held by a plan sponsor whose
25    principal place of business is in this State. In no event
26    shall the Association be obligated to cover more than

 

 

HB5493- 103 -LRB103 39189 RPS 69335 b

1    $5,000,000 in benefits with respect to all these
2    unallocated contracts.
3    In no event shall the Association be obligated to cover
4more than (1) an aggregate of $300,000 in benefits with
5respect to any one life under subparagraphs (i), (ii), and
6(iii) of this paragraph (b) except with respect to benefits
7for health benefit plans under item (B) of subparagraph (i) of
8this paragraph (b), in which case the aggregate liability of
9the Association shall not exceed $500,000 with respect to any
10one individual or (2) with respect to one owner of multiple
11nongroup policies of life insurance, whether the policy or
12contract owner is an individual, firm, corporation, or other
13person and whether the persons insured are officers, managers,
14employees, or other persons, $5,000,000 in benefits,
15regardless of the number of policies and contracts held by the
16owner.
17    The limitations set forth in this subsection are
18limitations on the benefits for which the Association is
19obligated before taking into account either its subrogation
20and assignment rights or the extent to which those benefits
21could be provided out of the assets of the impaired or
22insolvent insurer attributable to covered policies. The costs
23of the Association's obligations under this Article may be met
24by the use of assets attributable to covered policies or
25reimbursed to the Association pursuant to its subrogation and
26assignment rights.

 

 

HB5493- 104 -LRB103 39189 RPS 69335 b

1    For purposes of this Article, benefits provided by a
2long-term care rider to a life insurance policy or annuity
3contract shall be considered the same type of benefits as the
4base life insurance policy or annuity contract to which it
5relates.
6    (4) In performing its obligations to provide coverage
7under Section 531.08 of this Code, the Association shall not
8be required to guarantee, assume, reinsure, reissue, or
9perform or cause to be guaranteed, assumed, reinsured,
10reissued, or performed the contractual obligations of the
11insolvent or impaired insurer under a covered policy or
12contract that do not materially affect the economic values or
13economic benefits of the covered policy or contract.
14(Source: P.A. 100-687, eff. 8-3-18; 100-863, eff. 8-14-18.)
 
15    (215 ILCS 5/362a rep.)
16    Section 26. The Illinois Insurance Code is amended by
17repealing Section 362a.
 
18    Section 30. The Network Adequacy and Transparency Act is
19amended by changing Sections 5 and 10 as follows:
 
20    (215 ILCS 124/5)
21    Sec. 5. Definitions. In this Act:
22    "Authorized representative" means a person to whom a
23beneficiary has given express written consent to represent the

 

 

HB5493- 105 -LRB103 39189 RPS 69335 b

1beneficiary; a person authorized by law to provide substituted
2consent for a beneficiary; or the beneficiary's treating
3provider only when the beneficiary or his or her family member
4is unable to provide consent.
5    "Beneficiary" means an individual, an enrollee, an
6insured, a participant, or any other person entitled to
7reimbursement for covered expenses of or the discounting of
8provider fees for health care services under a program in
9which the beneficiary has an incentive to utilize the services
10of a provider that has entered into an agreement or
11arrangement with an insurer.
12    "Department" means the Department of Insurance.
13    "Director" means the Director of Insurance.
14    "Family caregiver" means a relative, partner, friend, or
15neighbor who has a significant relationship with the patient
16and administers or assists the patient with activities of
17daily living, instrumental activities of daily living, or
18other medical or nursing tasks for the quality and welfare of
19that patient.
20    "Insurer" means any entity that offers individual or group
21accident and health insurance, including, but not limited to,
22health maintenance organizations, preferred provider
23organizations, exclusive provider organizations, and other
24plan structures requiring network participation, excluding the
25medical assistance program under the Illinois Public Aid Code,
26the State employees group health insurance program, workers

 

 

HB5493- 106 -LRB103 39189 RPS 69335 b

1compensation insurance, and pharmacy benefit managers.
2    "Material change" means a significant reduction in the
3number of providers available in a network plan, including,
4but not limited to, a reduction of 10% or more in a specific
5type of providers, the removal of a major health system that
6causes a network to be significantly different from the
7network when the beneficiary purchased the network plan, or
8any change that would cause the network to no longer satisfy
9the requirements of this Act or the Department's rules for
10network adequacy and transparency.
11    "Network" means the group or groups of preferred providers
12providing services to a network plan.
13    "Network plan" means an individual or group policy of
14accident and health insurance that either requires a covered
15person to use or creates incentives, including financial
16incentives, for a covered person to use providers managed,
17owned, under contract with, or employed by the insurer.
18    "Ongoing course of treatment" means (1) treatment for a
19life-threatening condition, which is a disease or condition
20for which likelihood of death is probable unless the course of
21the disease or condition is interrupted; (2) treatment for a
22serious acute condition, defined as a disease or condition
23requiring complex ongoing care that the covered person is
24currently receiving, such as chemotherapy, radiation therapy,
25or post-operative visits; (3) a course of treatment for a
26health condition that a treating provider attests that

 

 

HB5493- 107 -LRB103 39189 RPS 69335 b

1discontinuing care by that provider would worsen the condition
2or interfere with anticipated outcomes; or (4) the third
3trimester of pregnancy through the post-partum period.
4    "Preferred provider" means any provider who has entered,
5either directly or indirectly, into an agreement with an
6employer or risk-bearing entity relating to health care
7services that may be rendered to beneficiaries under a network
8plan.
9    "Providers" means physicians licensed to practice medicine
10in all its branches, other health care professionals,
11hospitals, or other health care institutions that provide
12health care services.
13    "Telehealth" has the meaning given to that term in Section
14356z.22 of the Illinois Insurance Code.
15    "Telemedicine" has the meaning given to that term in
16Section 49.5 of the Medical Practice Act of 1987.
17    "Tiered network" means a network that identifies and
18groups some or all types of provider and facilities into
19specific groups to which different provider reimbursement,
20covered person cost-sharing or provider access requirements,
21or any combination thereof, apply for the same services.
22    "Woman's principal health care provider" means a physician
23licensed to practice medicine in all of its branches
24specializing in obstetrics, gynecology, or family practice.
25(Source: P.A. 102-92, eff. 7-9-21; 102-813, eff. 5-13-22.)
 

 

 

HB5493- 108 -LRB103 39189 RPS 69335 b

1    (215 ILCS 124/10)
2    Sec. 10. Network adequacy.
3    (a) An insurer providing a network plan shall file a
4description of all of the following with the Director:
5        (1) The written policies and procedures for adding
6    providers to meet patient needs based on increases in the
7    number of beneficiaries, changes in the
8    patient-to-provider ratio, changes in medical and health
9    care capabilities, and increased demand for services.
10        (2) The written policies and procedures for making
11    referrals within and outside the network.
12        (3) The written policies and procedures on how the
13    network plan will provide 24-hour, 7-day per week access
14    to network-affiliated primary care, emergency services,
15    and obstetrical and gynecological health care
16    professionals women's principal health care providers.
17    An insurer shall not prohibit a preferred provider from
18discussing any specific or all treatment options with
19beneficiaries irrespective of the insurer's position on those
20treatment options or from advocating on behalf of
21beneficiaries within the utilization review, grievance, or
22appeals processes established by the insurer in accordance
23with any rights or remedies available under applicable State
24or federal law.
25    (b) Insurers must file for review a description of the
26services to be offered through a network plan. The description

 

 

HB5493- 109 -LRB103 39189 RPS 69335 b

1shall include all of the following:
2        (1) A geographic map of the area proposed to be served
3    by the plan by county service area and zip code, including
4    marked locations for preferred providers.
5        (2) As deemed necessary by the Department, the names,
6    addresses, phone numbers, and specialties of the providers
7    who have entered into preferred provider agreements under
8    the network plan.
9        (3) The number of beneficiaries anticipated to be
10    covered by the network plan.
11        (4) An Internet website and toll-free telephone number
12    for beneficiaries and prospective beneficiaries to access
13    current and accurate lists of preferred providers,
14    additional information about the plan, as well as any
15    other information required by Department rule.
16        (5) A description of how health care services to be
17    rendered under the network plan are reasonably accessible
18    and available to beneficiaries. The description shall
19    address all of the following:
20            (A) the type of health care services to be
21        provided by the network plan;
22            (B) the ratio of physicians and other providers to
23        beneficiaries, by specialty and including primary care
24        physicians and facility-based physicians when
25        applicable under the contract, necessary to meet the
26        health care needs and service demands of the currently

 

 

HB5493- 110 -LRB103 39189 RPS 69335 b

1        enrolled population;
2            (C) the travel and distance standards for plan
3        beneficiaries in county service areas; and
4            (D) a description of how the use of telemedicine,
5        telehealth, or mobile care services may be used to
6        partially meet the network adequacy standards, if
7        applicable.
8        (6) A provision ensuring that whenever a beneficiary
9    has made a good faith effort, as evidenced by accessing
10    the provider directory, calling the network plan, and
11    calling the provider, to utilize preferred providers for a
12    covered service and it is determined the insurer does not
13    have the appropriate preferred providers due to
14    insufficient number, type, unreasonable travel distance or
15    delay, or preferred providers refusing to provide a
16    covered service because it is contrary to the conscience
17    of the preferred providers, as protected by the Health
18    Care Right of Conscience Act, the insurer shall ensure,
19    directly or indirectly, by terms contained in the payer
20    contract, that the beneficiary will be provided the
21    covered service at no greater cost to the beneficiary than
22    if the service had been provided by a preferred provider.
23    This paragraph (6) does not apply to: (A) a beneficiary
24    who willfully chooses to access a non-preferred provider
25    for health care services available through the panel of
26    preferred providers, or (B) a beneficiary enrolled in a

 

 

HB5493- 111 -LRB103 39189 RPS 69335 b

1    health maintenance organization. In these circumstances,
2    the contractual requirements for non-preferred provider
3    reimbursements shall apply unless Section 356z.3a of the
4    Illinois Insurance Code requires otherwise. In no event
5    shall a beneficiary who receives care at a participating
6    health care facility be required to search for
7    participating providers under the circumstances described
8    in subsection (b) or (b-5) of Section 356z.3a of the
9    Illinois Insurance Code except under the circumstances
10    described in paragraph (2) of subsection (b-5).
11        (7) A provision that the beneficiary shall receive
12    emergency care coverage such that payment for this
13    coverage is not dependent upon whether the emergency
14    services are performed by a preferred or non-preferred
15    provider and the coverage shall be at the same benefit
16    level as if the service or treatment had been rendered by a
17    preferred provider. For purposes of this paragraph (7),
18    "the same benefit level" means that the beneficiary is
19    provided the covered service at no greater cost to the
20    beneficiary than if the service had been provided by a
21    preferred provider. This provision shall be consistent
22    with Section 356z.3a of the Illinois Insurance Code.
23        (8) A limitation that, if the plan provides that the
24    beneficiary will incur a penalty for failing to
25    pre-certify inpatient hospital treatment, the penalty may
26    not exceed $1,000 per occurrence in addition to the plan

 

 

HB5493- 112 -LRB103 39189 RPS 69335 b

1    cost-sharing cost sharing provisions.
2    (c) The network plan shall demonstrate to the Director a
3minimum ratio of providers to plan beneficiaries as required
4by the Department.
5        (1) The ratio of physicians or other providers to plan
6    beneficiaries shall be established annually by the
7    Department in consultation with the Department of Public
8    Health based upon the guidance from the federal Centers
9    for Medicare and Medicaid Services. The Department shall
10    not establish ratios for vision or dental providers who
11    provide services under dental-specific or vision-specific
12    benefits. The Department shall consider establishing
13    ratios for the following physicians or other providers:
14            (A) Primary Care;
15            (B) Pediatrics;
16            (C) Cardiology;
17            (D) Gastroenterology;
18            (E) General Surgery;
19            (F) Neurology;
20            (G) OB/GYN;
21            (H) Oncology/Radiation;
22            (I) Ophthalmology;
23            (J) Urology;
24            (K) Behavioral Health;
25            (L) Allergy/Immunology;
26            (M) Chiropractic;

 

 

HB5493- 113 -LRB103 39189 RPS 69335 b

1            (N) Dermatology;
2            (O) Endocrinology;
3            (P) Ears, Nose, and Throat (ENT)/Otolaryngology;
4            (Q) Infectious Disease;
5            (R) Nephrology;
6            (S) Neurosurgery;
7            (T) Orthopedic Surgery;
8            (U) Physiatry/Rehabilitative;
9            (V) Plastic Surgery;
10            (W) Pulmonary;
11            (X) Rheumatology;
12            (Y) Anesthesiology;
13            (Z) Pain Medicine;
14            (AA) Pediatric Specialty Services;
15            (BB) Outpatient Dialysis; and
16            (CC) HIV.
17        (2) The Director shall establish a process for the
18    review of the adequacy of these standards, along with an
19    assessment of additional specialties to be included in the
20    list under this subsection (c).
21    (d) The network plan shall demonstrate to the Director
22maximum travel and distance standards for plan beneficiaries,
23which shall be established annually by the Department in
24consultation with the Department of Public Health based upon
25the guidance from the federal Centers for Medicare and
26Medicaid Services. These standards shall consist of the

 

 

HB5493- 114 -LRB103 39189 RPS 69335 b

1maximum minutes or miles to be traveled by a plan beneficiary
2for each county type, such as large counties, metro counties,
3or rural counties as defined by Department rule.
4    The maximum travel time and distance standards must
5include standards for each physician and other provider
6category listed for which ratios have been established.
7    The Director shall establish a process for the review of
8the adequacy of these standards along with an assessment of
9additional specialties to be included in the list under this
10subsection (d).
11    (d-5)(1) Every insurer shall ensure that beneficiaries
12have timely and proximate access to treatment for mental,
13emotional, nervous, or substance use disorders or conditions
14in accordance with the provisions of paragraph (4) of
15subsection (a) of Section 370c of the Illinois Insurance Code.
16Insurers shall use a comparable process, strategy, evidentiary
17standard, and other factors in the development and application
18of the network adequacy standards for timely and proximate
19access to treatment for mental, emotional, nervous, or
20substance use disorders or conditions and those for the access
21to treatment for medical and surgical conditions. As such, the
22network adequacy standards for timely and proximate access
23shall equally be applied to treatment facilities and providers
24for mental, emotional, nervous, or substance use disorders or
25conditions and specialists providing medical or surgical
26benefits pursuant to the parity requirements of Section 370c.1

 

 

HB5493- 115 -LRB103 39189 RPS 69335 b

1of the Illinois Insurance Code and the federal Paul Wellstone
2and Pete Domenici Mental Health Parity and Addiction Equity
3Act of 2008. Notwithstanding the foregoing, the network
4adequacy standards for timely and proximate access to
5treatment for mental, emotional, nervous, or substance use
6disorders or conditions shall, at a minimum, satisfy the
7following requirements:
8        (A) For beneficiaries residing in the metropolitan
9    counties of Cook, DuPage, Kane, Lake, McHenry, and Will,
10    network adequacy standards for timely and proximate access
11    to treatment for mental, emotional, nervous, or substance
12    use disorders or conditions means a beneficiary shall not
13    have to travel longer than 30 minutes or 30 miles from the
14    beneficiary's residence to receive outpatient treatment
15    for mental, emotional, nervous, or substance use disorders
16    or conditions. Beneficiaries shall not be required to wait
17    longer than 10 business days between requesting an initial
18    appointment and being seen by the facility or provider of
19    mental, emotional, nervous, or substance use disorders or
20    conditions for outpatient treatment or to wait longer than
21    20 business days between requesting a repeat or follow-up
22    appointment and being seen by the facility or provider of
23    mental, emotional, nervous, or substance use disorders or
24    conditions for outpatient treatment; however, subject to
25    the protections of paragraph (3) of this subsection, a
26    network plan shall not be held responsible if the

 

 

HB5493- 116 -LRB103 39189 RPS 69335 b

1    beneficiary or provider voluntarily chooses to schedule an
2    appointment outside of these required time frames.
3        (B) For beneficiaries residing in Illinois counties
4    other than those counties listed in subparagraph (A) of
5    this paragraph, network adequacy standards for timely and
6    proximate access to treatment for mental, emotional,
7    nervous, or substance use disorders or conditions means a
8    beneficiary shall not have to travel longer than 60
9    minutes or 60 miles from the beneficiary's residence to
10    receive outpatient treatment for mental, emotional,
11    nervous, or substance use disorders or conditions.
12    Beneficiaries shall not be required to wait longer than 10
13    business days between requesting an initial appointment
14    and being seen by the facility or provider of mental,
15    emotional, nervous, or substance use disorders or
16    conditions for outpatient treatment or to wait longer than
17    20 business days between requesting a repeat or follow-up
18    appointment and being seen by the facility or provider of
19    mental, emotional, nervous, or substance use disorders or
20    conditions for outpatient treatment; however, subject to
21    the protections of paragraph (3) of this subsection, a
22    network plan shall not be held responsible if the
23    beneficiary or provider voluntarily chooses to schedule an
24    appointment outside of these required time frames.
25    (2) For beneficiaries residing in all Illinois counties,
26network adequacy standards for timely and proximate access to

 

 

HB5493- 117 -LRB103 39189 RPS 69335 b

1treatment for mental, emotional, nervous, or substance use
2disorders or conditions means a beneficiary shall not have to
3travel longer than 60 minutes or 60 miles from the
4beneficiary's residence to receive inpatient or residential
5treatment for mental, emotional, nervous, or substance use
6disorders or conditions.
7    (3) If there is no in-network facility or provider
8available for a beneficiary to receive timely and proximate
9access to treatment for mental, emotional, nervous, or
10substance use disorders or conditions in accordance with the
11network adequacy standards outlined in this subsection, the
12insurer shall provide necessary exceptions to its network to
13ensure admission and treatment with a provider or at a
14treatment facility in accordance with the network adequacy
15standards in this subsection.
16    (e) Except for network plans solely offered as a group
17health plan, these ratio and time and distance standards apply
18to the lowest cost-sharing tier of any tiered network.
19    (f) The network plan may consider use of other health care
20service delivery options, such as telemedicine or telehealth,
21mobile clinics, and centers of excellence, or other ways of
22delivering care to partially meet the requirements set under
23this Section.
24    (g) Except for the requirements set forth in subsection
25(d-5), insurers who are not able to comply with the provider
26ratios and time and distance standards established by the

 

 

HB5493- 118 -LRB103 39189 RPS 69335 b

1Department may request an exception to these requirements from
2the Department. The Department may grant an exception in the
3following circumstances:
4        (1) if no providers or facilities meet the specific
5    time and distance standard in a specific service area and
6    the insurer (i) discloses information on the distance and
7    travel time points that beneficiaries would have to travel
8    beyond the required criterion to reach the next closest
9    contracted provider outside of the service area and (ii)
10    provides contact information, including names, addresses,
11    and phone numbers for the next closest contracted provider
12    or facility;
13        (2) if patterns of care in the service area do not
14    support the need for the requested number of provider or
15    facility type and the insurer provides data on local
16    patterns of care, such as claims data, referral patterns,
17    or local provider interviews, indicating where the
18    beneficiaries currently seek this type of care or where
19    the physicians currently refer beneficiaries, or both; or
20        (3) other circumstances deemed appropriate by the
21    Department consistent with the requirements of this Act.
22    (h) Insurers are required to report to the Director any
23material change to an approved network plan within 15 days
24after the change occurs and any change that would result in
25failure to meet the requirements of this Act. Upon notice from
26the insurer, the Director shall reevaluate the network plan's

 

 

HB5493- 119 -LRB103 39189 RPS 69335 b

1compliance with the network adequacy and transparency
2standards of this Act.
3(Source: P.A. 102-144, eff. 1-1-22; 102-901, eff. 7-1-22;
4102-1117, eff. 1-13-23.)
 
5    Section 35. The Health Maintenance Organization Act is
6amended by changing Sections 4.5-1, 5-3, and 5-3.1 as follows:
 
7    (215 ILCS 125/4.5-1)
8    Sec. 4.5-1. Point-of-service health service contracts.
9    (a) A health maintenance organization that offers a
10point-of-service contract:
11        (1) must include as in-plan covered services all
12    services required by law to be provided by a health
13    maintenance organization;
14        (2) must provide incentives, which shall include
15    financial incentives, for enrollees to use in-plan covered
16    services;
17        (3) may not offer services out-of-plan without
18    providing those services on an in-plan basis;
19        (4) may include annual out-of-pocket limits and
20    lifetime maximum benefits allowances for out-of-plan
21    services that are separate from any limits or allowances
22    applied to in-plan services;
23        (5) may not consider emergency services, authorized
24    referral services, or non-routine services obtained out of

 

 

HB5493- 120 -LRB103 39189 RPS 69335 b

1    the service area to be point-of-service services;
2        (6) may treat as out-of-plan services those services
3    that an enrollee obtains from a participating provider,
4    but for which the proper authorization was not given by
5    the health maintenance organization; and
6        (7) after January 1, 2003 (the effective date of
7    Public Act 92-579), must include the following disclosure
8    on its point-of-service contracts and evidences of
9    coverage: "WARNING, LIMITED BENEFITS WILL BE PAID WHEN
10    NON-PARTICIPATING PROVIDERS ARE USED. YOU CAN EXPECT TO
11    PAY MORE THAN THE COST-SHARING AMOUNT DEFINED IN THE
12    POLICY IN NON-EMERGENCY SITUATIONS. Except in limited
13    situations governed by the federal No Surprises Act or
14    Section 356z.3a of the Illinois Insurance Code (215 ILCS
15    5/356z.3a), non-participating providers furnishing
16    non-emergency services may bill members for any amount up
17    to the billed charge after the plan has paid its portion of
18    the bill. If you elect to use a non-participating
19    provider, plan benefit payments will be determined
20    according to your policy's fee schedule, usual and
21    customary charge (which is determined by comparing charges
22    for similar services adjusted to the geographical area
23    where the services are performed), or other method as
24    defined by the policy. Participating providers have agreed
25    to ONLY bill members the cost-sharing amounts. You should
26    be aware that when you elect to utilize the services of a

 

 

HB5493- 121 -LRB103 39189 RPS 69335 b

1    non-participating provider for a covered service in
2    non-emergency situations, benefit payments to such
3    non-participating provider are not based upon the amount
4    billed. The basis of your benefit payment will be
5    determined according to your policy's fee schedule, usual
6    and customary charge (which is determined by comparing
7    charges for similar services adjusted to the geographical
8    area where the services are performed), or other method as
9    defined by the policy. YOU CAN EXPECT TO PAY MORE THAN THE
10    COINSURANCE AMOUNT DEFINED IN THE POLICY AFTER THE PLAN
11    HAS PAID ITS REQUIRED PORTION. Non-participating providers
12    may bill members for any amount up to the billed charge
13    after the plan has paid its portion of the bill, except as
14    provided in Section 356z.3a of the Illinois Insurance Code
15    for covered services received at a participating health
16    care facility from a non-participating provider that are:
17    (a) ancillary services, (b) items or services furnished as
18    a result of unforeseen, urgent medical needs that arise at
19    the time the item or service is furnished, or (c) items or
20    services received when the facility or the
21    non-participating provider fails to satisfy the notice and
22    consent criteria specified under Section 356z.3a.
23    Participating providers have agreed to accept discounted
24    payments for services with no additional billing to the
25    member other than co-insurance and deductible amounts. You
26    may obtain further information about the participating

 

 

HB5493- 122 -LRB103 39189 RPS 69335 b

1    status of professional providers and information on
2    out-of-pocket expenses by calling the toll-free toll free
3    telephone number on your identification card.".
4    (b) A health maintenance organization offering a
5point-of-service contract is subject to all of the following
6limitations:
7        (1) The health maintenance organization may not expend
8    in any calendar quarter more than 20% of its total
9    expenditures for all its members for out-of-plan covered
10    services.
11        (2) If the amount specified in item (1) of this
12    subsection is exceeded by 2% in a quarter, the health
13    maintenance organization must effect compliance with item
14    (1) of this subsection by the end of the following
15    quarter.
16        (3) If compliance with the amount specified in item
17    (1) of this subsection is not demonstrated in the health
18    maintenance organization's next quarterly report, the
19    health maintenance organization may not offer the
20    point-of-service contract to new groups or include the
21    point-of-service option in the renewal of an existing
22    group until compliance with the amount specified in item
23    (1) of this subsection is demonstrated or until otherwise
24    allowed by the Director.
25        (4) A health maintenance organization failing, without
26    just cause, to comply with the provisions of this

 

 

HB5493- 123 -LRB103 39189 RPS 69335 b

1    subsection shall be required, after notice and hearing, to
2    pay a penalty of $250 for each day out of compliance, to be
3    recovered by the Director. Any penalty recovered shall be
4    paid into the General Revenue Fund. The Director may
5    reduce the penalty if the health maintenance organization
6    demonstrates to the Director that the imposition of the
7    penalty would constitute a financial hardship to the
8    health maintenance organization.
9    (c) A health maintenance organization that offers a
10point-of-service product must do all of the following:
11        (1) File a quarterly financial statement detailing
12    compliance with the requirements of subsection (b).
13        (2) Track out-of-plan, point-of-service utilization
14    separately from in-plan or non-point-of-service,
15    out-of-plan emergency care, referral care, and urgent care
16    out of the service area utilization.
17        (3) Record out-of-plan utilization in a manner that
18    will permit such utilization and cost reporting as the
19    Director may, by rule, require.
20        (4) Demonstrate to the Director's satisfaction that
21    the health maintenance organization has the fiscal,
22    administrative, and marketing capacity to control its
23    point-of-service enrollment, utilization, and costs so as
24    not to jeopardize the financial security of the health
25    maintenance organization.
26        (5) Maintain, in addition to any other deposit

 

 

HB5493- 124 -LRB103 39189 RPS 69335 b

1    required under this Act, the deposit required by Section
2    2-6.
3        (6) Maintain cash and cash equivalents of sufficient
4    amount to fully liquidate 10 days' average claim payments,
5    subject to review by the Director.
6        (7) Maintain and file with the Director, reinsurance
7    coverage protecting against catastrophic losses on
8    out-of-network point-of-service services. Deductibles may
9    not exceed $100,000 per covered life per year, and the
10    portion of risk retained by the health maintenance
11    organization once deductibles have been satisfied may not
12    exceed 20%. Reinsurance must be placed with licensed
13    authorized reinsurers qualified to do business in this
14    State.
15    (d) A health maintenance organization may not issue a
16point-of-service contract until it has filed and had approved
17by the Director a plan to comply with the provisions of this
18Section. The compliance plan must, at a minimum, include
19provisions demonstrating that the health maintenance
20organization will do all of the following:
21        (1) Design the benefit levels and conditions of
22    coverage for in-plan covered services and out-of-plan
23    covered services as required by this Article.
24        (2) Provide or arrange for the provision of adequate
25    systems to:
26            (A) process and pay claims for all out-of-plan

 

 

HB5493- 125 -LRB103 39189 RPS 69335 b

1        covered services;
2            (B) meet the requirements for point-of-service
3        contracts set forth in this Section and any additional
4        requirements that may be set forth by the Director;
5        and
6            (C) generate accurate data and financial and
7        regulatory reports on a timely basis so that the
8        Department of Insurance can evaluate the health
9        maintenance organization's experience with the
10        point-of-service contract and monitor compliance with
11        point-of-service contract provisions.
12        (3) Comply with the requirements of subsections (b)
13    and (c).
14(Source: P.A. 102-901, eff. 1-1-23; 103-154, eff. 6-30-23.)
 
15    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
16    Sec. 5-3. Insurance Code provisions.
17    (a) Health Maintenance Organizations shall be subject to
18the provisions of Sections 133, 134, 136, 137, 139, 140,
19141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
20154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49,
21355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356v,
22356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
23356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
24356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21, 356z.22,
25356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29, 356z.30,

 

 

HB5493- 126 -LRB103 39189 RPS 69335 b

1356z.30a, 356z.31, 356z.32, 356z.33, 356z.34, 356z.35,
2356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41, 356z.44,
3356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50, 356z.51,
4356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58, 356z.59,
5356z.60, 356z.61, 356z.62, 356z.63, 356z.64, 356z.65, 356z.66,
6356z.67, 356z.68, 356z.69, 356z.70, 364, 364.01, 364.3, 367.2,
7367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370c, 370c.1,
8401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, and
9444.1, paragraph (c) of subsection (2) of Section 367, and
10Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV,
11XXVI, and XXXIIB of the Illinois Insurance Code.
12    (b) For purposes of the Illinois Insurance Code, except
13for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
14Health Maintenance Organizations in the following categories
15are deemed to be "domestic companies":
16        (1) a corporation authorized under the Dental Service
17    Plan Act or the Voluntary Health Services Plans Act;
18        (2) a corporation organized under the laws of this
19    State; or
20        (3) a corporation organized under the laws of another
21    state, 30% or more of the enrollees of which are residents
22    of this State, except a corporation subject to
23    substantially the same requirements in its state of
24    organization as is a "domestic company" under Article VIII
25    1/2 of the Illinois Insurance Code.
26    (c) In considering the merger, consolidation, or other

 

 

HB5493- 127 -LRB103 39189 RPS 69335 b

1acquisition of control of a Health Maintenance Organization
2pursuant to Article VIII 1/2 of the Illinois Insurance Code,
3        (1) the Director shall give primary consideration to
4    the continuation of benefits to enrollees and the
5    financial conditions of the acquired Health Maintenance
6    Organization after the merger, consolidation, or other
7    acquisition of control takes effect;
8        (2)(i) the criteria specified in subsection (1)(b) of
9    Section 131.8 of the Illinois Insurance Code shall not
10    apply and (ii) the Director, in making his determination
11    with respect to the merger, consolidation, or other
12    acquisition of control, need not take into account the
13    effect on competition of the merger, consolidation, or
14    other acquisition of control;
15        (3) the Director shall have the power to require the
16    following information:
17            (A) certification by an independent actuary of the
18        adequacy of the reserves of the Health Maintenance
19        Organization sought to be acquired;
20            (B) pro forma financial statements reflecting the
21        combined balance sheets of the acquiring company and
22        the Health Maintenance Organization sought to be
23        acquired as of the end of the preceding year and as of
24        a date 90 days prior to the acquisition, as well as pro
25        forma financial statements reflecting projected
26        combined operation for a period of 2 years;

 

 

HB5493- 128 -LRB103 39189 RPS 69335 b

1            (C) a pro forma business plan detailing an
2        acquiring party's plans with respect to the operation
3        of the Health Maintenance Organization sought to be
4        acquired for a period of not less than 3 years; and
5            (D) such other information as the Director shall
6        require.
7    (d) The provisions of Article VIII 1/2 of the Illinois
8Insurance Code and this Section 5-3 shall apply to the sale by
9any health maintenance organization of greater than 10% of its
10enrollee population (including, without limitation, the health
11maintenance organization's right, title, and interest in and
12to its health care certificates).
13    (e) In considering any management contract or service
14agreement subject to Section 141.1 of the Illinois Insurance
15Code, the Director (i) shall, in addition to the criteria
16specified in Section 141.2 of the Illinois Insurance Code,
17take into account the effect of the management contract or
18service agreement on the continuation of benefits to enrollees
19and the financial condition of the health maintenance
20organization to be managed or serviced, and (ii) need not take
21into account the effect of the management contract or service
22agreement on competition.
23    (f) Except for small employer groups as defined in the
24Small Employer Rating, Renewability and Portability Health
25Insurance Act and except for medicare supplement policies as
26defined in Section 363 of the Illinois Insurance Code, a

 

 

HB5493- 129 -LRB103 39189 RPS 69335 b

1Health Maintenance Organization may by contract agree with a
2group or other enrollment unit to effect refunds or charge
3additional premiums under the following terms and conditions:
4        (i) the amount of, and other terms and conditions with
5    respect to, the refund or additional premium are set forth
6    in the group or enrollment unit contract agreed in advance
7    of the period for which a refund is to be paid or
8    additional premium is to be charged (which period shall
9    not be less than one year); and
10        (ii) the amount of the refund or additional premium
11    shall not exceed 20% of the Health Maintenance
12    Organization's profitable or unprofitable experience with
13    respect to the group or other enrollment unit for the
14    period (and, for purposes of a refund or additional
15    premium, the profitable or unprofitable experience shall
16    be calculated taking into account a pro rata share of the
17    Health Maintenance Organization's administrative and
18    marketing expenses, but shall not include any refund to be
19    made or additional premium to be paid pursuant to this
20    subsection (f)). The Health Maintenance Organization and
21    the group or enrollment unit may agree that the profitable
22    or unprofitable experience may be calculated taking into
23    account the refund period and the immediately preceding 2
24    plan years.
25    The Health Maintenance Organization shall include a
26statement in the evidence of coverage issued to each enrollee

 

 

HB5493- 130 -LRB103 39189 RPS 69335 b

1describing the possibility of a refund or additional premium,
2and upon request of any group or enrollment unit, provide to
3the group or enrollment unit a description of the method used
4to calculate (1) the Health Maintenance Organization's
5profitable experience with respect to the group or enrollment
6unit and the resulting refund to the group or enrollment unit
7or (2) the Health Maintenance Organization's unprofitable
8experience with respect to the group or enrollment unit and
9the resulting additional premium to be paid by the group or
10enrollment unit.
11    In no event shall the Illinois Health Maintenance
12Organization Guaranty Association be liable to pay any
13contractual obligation of an insolvent organization to pay any
14refund authorized under this Section.
15    (g) Rulemaking authority to implement Public Act 95-1045,
16if any, is conditioned on the rules being adopted in
17accordance with all provisions of the Illinois Administrative
18Procedure Act and all rules and procedures of the Joint
19Committee on Administrative Rules; any purported rule not so
20adopted, for whatever reason, is unauthorized.
21(Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
22102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
231-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
24eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
25102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
261-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,

 

 

HB5493- 131 -LRB103 39189 RPS 69335 b

1eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
2103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
36-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
4eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.)
 
5    (215 ILCS 125/5-3.1)
6    Sec. 5-3.1. Access to obstetrical and gynecological care
7Woman's health care provider. Health maintenance organizations
8are subject to the provisions of Section 356r of the Illinois
9Insurance Code.
10(Source: P.A. 89-514, eff. 7-17-96.)
 
11    Section 40. The Limited Health Service Organization Act is
12amended by changing Section 4002.1 as follows:
 
13    (215 ILCS 130/4002.1)
14    Sec. 4002.1. Access to obstetrical and gynecological care
15Woman's health care provider. Limited health service
16organizations are subject to the provisions of Section 356r of
17the Illinois Insurance Code.
18(Source: P.A. 89-514, eff. 7-17-96.)
 
19    Section 45. The Illinois Public Aid Code is amended by
20changing Section 5-16.9 as follows:
 
21    (305 ILCS 5/5-16.9)

 

 

HB5493- 132 -LRB103 39189 RPS 69335 b

1    Sec. 5-16.9. Access to obstetrical and gynecological care
2Woman's health care provider. The medical assistance program
3is subject to the provisions of Section 356r of the Illinois
4Insurance Code. The Illinois Department shall adopt rules to
5implement the requirements of Section 356r of the Illinois
6Insurance Code in the medical assistance program including
7managed care components.
8    On and after July 1, 2012, the Department shall reduce any
9rate of reimbursement for services or other payments or alter
10any methodologies authorized by this Code to reduce any rate
11of reimbursement for services or other payments in accordance
12with Section 5-5e.
13(Source: P.A. 97-689, eff. 6-14-12.)
 
14    Section 95. No acceleration or delay. Where this Act makes
15changes in a statute that is represented in this Act by text
16that is not yet or no longer in effect (for example, a Section
17represented by multiple versions), the use of that text does
18not accelerate or delay the taking effect of (i) the changes
19made by this Act or (ii) provisions derived from any other
20Public Act.
 
21    Section 99. Effective date. This Act takes effect upon
22becoming law, except that the changes to Sections 356r, 356s,
23356z.3, and 367a of the Illinois Insurance Code and Section
244.5-1 of the Health Maintenance Organization Act take effect
25January 1, 2025.

 

 

HB5493- 133 -LRB103 39189 RPS 69335 b

1 INDEX
2 Statutes amended in order of appearance
3    5 ILCS 375/6.7
4    55 ILCS 5/5-1069.5
5    65 ILCS 5/10-4-2.5
6    105 ILCS 5/10-22.3d
7    215 ILCS 5/4from Ch. 73, par. 616
8    215 ILCS 5/155.23from Ch. 73, par. 767.23
9    215 ILCS 5/352from Ch. 73, par. 964
10    215 ILCS 5/352b
11    215 ILCS 5/356afrom Ch. 73, par. 968a
12    215 ILCS 5/356bfrom Ch. 73, par. 968b
13    215 ILCS 5/356dfrom Ch. 73, par. 968d
14    215 ILCS 5/356efrom Ch. 73, par. 968e
15    215 ILCS 5/356ffrom Ch. 73, par. 968f
16    215 ILCS 5/356Kfrom Ch. 73, par. 968K
17    215 ILCS 5/356Lfrom Ch. 73, par. 968L
18    215 ILCS 5/356r
19    215 ILCS 5/356s
20    215 ILCS 5/356z.3
21    215 ILCS 5/356z.33
22    215 ILCS 5/367afrom Ch. 73, par. 979a
23    215 ILCS 5/370efrom Ch. 73, par. 982e
24    215 ILCS 5/370ifrom Ch. 73, par. 982i
25    215 ILCS 5/408from Ch. 73, par. 1020

 

 

HB5493- 134 -LRB103 39189 RPS 69335 b

1    215 ILCS 5/412from Ch. 73, par. 1024
2    215 ILCS 5/531.03from Ch. 73, par. 1065.80-3
3    215 ILCS 5/362a rep.
4    215 ILCS 124/5
5    215 ILCS 124/10
6    215 ILCS 125/4.5-1
7    215 ILCS 125/5-3from Ch. 111 1/2, par. 1411.2
8    215 ILCS 125/5-3.1
9    215 ILCS 130/4002.1
10    305 ILCS 5/5-16.9