HB5493 EnrolledLRB103 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 Sections 6.7 and 6.11 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    (5 ILCS 375/6.11)
13    Sec. 6.11. Required health benefits; Illinois Insurance
14Code requirements. The program of health benefits shall
15provide the post-mastectomy care benefits required to be
16covered by a policy of accident and health insurance under
17Section 356t of the Illinois Insurance Code. The program of
18health benefits shall provide the coverage required under
19Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
20356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
21356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
22356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32,

 

 

HB5493 Enrolled- 2 -LRB103 39189 RPS 69335 b

1356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
2356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59,
3356z.60, and 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68,
4and 356z.70 of the Illinois Insurance Code. The program of
5health benefits must comply with Sections 155.22a, 155.37,
6355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of the
7Illinois Insurance Code. The program of health benefits shall
8provide the coverage required under Section 356m of the
9Illinois Insurance Code and, for the employees of the State
10Employee Group Insurance Program only, the coverage as also
11provided in Section 6.11B of this Act. The Department of
12Insurance shall enforce the requirements of this Section with
13respect to Sections 370c and 370c.1 of the Illinois Insurance
14Code; all other requirements of this Section shall be enforced
15by the Department of Central Management Services.
16    Rulemaking authority to implement Public Act 95-1045, if
17any, is conditioned on the rules being adopted in accordance
18with all provisions of the Illinois Administrative Procedure
19Act and all rules and procedures of the Joint Committee on
20Administrative Rules; any purported rule not so adopted, for
21whatever reason, is unauthorized.
22(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
23102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
241-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768,
25eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
26102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.

 

 

HB5493 Enrolled- 3 -LRB103 39189 RPS 69335 b

11-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84,
2eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24;
3103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff.
48-11-23; revised 8-29-23.)
 
5    Section 10. The Counties Code is amended by changing
6Sections 5-1069.3 and 5-1069.5 as follows:
 
7    (55 ILCS 5/5-1069.3)
8    Sec. 5-1069.3. Required health benefits. If a county,
9including a home rule county, is a self-insurer for purposes
10of providing health insurance coverage for its employees, the
11coverage shall include coverage for the post-mastectomy care
12benefits required to be covered by a policy of accident and
13health insurance under Section 356t and the coverage required
14under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356w, 356x,
15356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
16356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
17356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, 356z.36,
18356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
19356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and
20356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70
21of the Illinois Insurance Code. The coverage shall comply with
22Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
23Insurance Code. The Department of Insurance shall enforce the
24requirements of this Section. The requirement that health

 

 

HB5493 Enrolled- 4 -LRB103 39189 RPS 69335 b

1benefits be covered as provided in this Section is an
2exclusive power and function of the State and is a denial and
3limitation under Article VII, Section 6, subsection (h) of the
4Illinois Constitution. A home rule county to which this
5Section applies must comply with every provision of this
6Section.
7    Rulemaking authority to implement Public Act 95-1045, if
8any, is conditioned on the rules being adopted in accordance
9with all provisions of the Illinois Administrative Procedure
10Act and all rules and procedures of the Joint Committee on
11Administrative Rules; any purported rule not so adopted, for
12whatever reason, is unauthorized.
13(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
14102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
151-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
16eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
17102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
181-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
19eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
20103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
218-29-23.)
 
22    (55 ILCS 5/5-1069.5)
23    Sec. 5-1069.5. Access to obstetrical and gynecological
24care Woman's health care provider. All counties, including
25home rule counties, are subject to the provisions of Section

 

 

HB5493 Enrolled- 5 -LRB103 39189 RPS 69335 b

1356r of the Illinois Insurance Code. The requirement under
2this Section that health care benefits provided by counties
3comply with Section 356r of the Illinois Insurance Code is an
4exclusive power and function of the State and is a denial and
5limitation of home rule county powers under Article VII,
6Section 6, subsection (h) of the Illinois Constitution.
7(Source: P.A. 89-514, eff. 7-17-96; 90-14, eff. 7-1-97.)
 
8    Section 15. The Illinois Municipal Code is amended by
9changing Sections 10-4-2.3 and 10-4-2.5 as follows:
 
10    (65 ILCS 5/10-4-2.3)
11    Sec. 10-4-2.3. Required health benefits. If a
12municipality, including a home rule municipality, is a
13self-insurer for purposes of providing health insurance
14coverage for its employees, the coverage shall include
15coverage for the post-mastectomy care benefits required to be
16covered by a policy of accident and health insurance under
17Section 356t and the coverage required under Sections 356g,
18356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.4, 356z.4a,
19356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
20356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
21356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
22356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
23356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and 356z.62,
24356z.64, 356z.67, 356z.68, and 356z.70 of the Illinois

 

 

HB5493 Enrolled- 6 -LRB103 39189 RPS 69335 b

1Insurance Code. The coverage shall comply with Sections
2155.22a, 355b, 356z.19, and 370c of the Illinois Insurance
3Code. The Department of Insurance shall enforce the
4requirements of this Section. The requirement that health
5benefits be covered as provided in this is an exclusive power
6and function of the State and is a denial and limitation under
7Article VII, Section 6, subsection (h) of the Illinois
8Constitution. A home rule municipality to which this Section
9applies must comply with every provision of this Section.
10    Rulemaking authority to implement Public Act 95-1045, if
11any, is conditioned on the rules being adopted in accordance
12with all provisions of the Illinois Administrative Procedure
13Act and all rules and procedures of the Joint Committee on
14Administrative Rules; any purported rule not so adopted, for
15whatever reason, is unauthorized.
16(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
17102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
181-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
19eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
20102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
211-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
22eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
23103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
248-29-23.)
 
25    (65 ILCS 5/10-4-2.5)

 

 

HB5493 Enrolled- 7 -LRB103 39189 RPS 69335 b

1    Sec. 10-4-2.5. Access to obstetrical and gynecological
2care Woman's health care provider. The corporate authorities
3of all municipalities are subject to the provisions of Section
4356r of the Illinois Insurance Code. The requirement under
5this Section that health care benefits provided by
6municipalities comply with Section 356r of the Illinois
7Insurance Code is an exclusive power and function of the State
8and is a denial and limitation of home rule municipality
9powers under Article VII, Section 6, subsection (h) of the
10Illinois Constitution.
11(Source: P.A. 89-514, eff. 7-17-96; 90-14, eff. 7-1-97.)
 
12    Section 20. The School Code is amended by changing
13Sections 10-22.3d and 10-22.3f as follows:
 
14    (105 ILCS 5/10-22.3d)
15    Sec. 10-22.3d. Access to obstetrical and gynecological
16care Woman's health care provider. Insurance protection and
17benefits for employees are subject to the provisions of
18Section 356r of the Illinois Insurance Code.
19(Source: P.A. 89-514, eff. 7-17-96; 90-14, eff. 7-1-97.)
 
20    (105 ILCS 5/10-22.3f)
21    Sec. 10-22.3f. Required health benefits. Insurance
22protection and benefits for employees shall provide the
23post-mastectomy care benefits required to be covered by a

 

 

HB5493 Enrolled- 8 -LRB103 39189 RPS 69335 b

1policy of accident and health insurance under Section 356t and
2the coverage required under Sections 356g, 356g.5, 356g.5-1,
3356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8,
4356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
5356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32,
6356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
7356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60,
8and 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, and
9356z.70 of the Illinois Insurance Code. Insurance policies
10shall comply with Section 356z.19 of the Illinois Insurance
11Code. The coverage shall comply with Sections 155.22a, 355b,
12and 370c of the Illinois Insurance Code. The Department of
13Insurance shall enforce the requirements of this Section.
14    Rulemaking authority to implement Public Act 95-1045, if
15any, is conditioned on the rules being adopted in accordance
16with all provisions of the Illinois Administrative Procedure
17Act and all rules and procedures of the Joint Committee on
18Administrative Rules; any purported rule not so adopted, for
19whatever reason, is unauthorized.
20(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
21102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
221-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,
23eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
24102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.
251-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,
26eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;

 

 

HB5493 Enrolled- 9 -LRB103 39189 RPS 69335 b

1103-551, eff. 8-11-23; revised 8-29-23.)
 
2    Section 25. The Illinois Insurance Code is amended by
3changing Sections 4, 352, 352b, 356a, 356b, 356d, 356e, 356f,
4356K, 356L, 356r, 356s, 356z.3, 356z.33, 367a, 370e, 370i,
5408, 412, and 531.03 as follows:
 
6    (215 ILCS 5/4)  (from Ch. 73, par. 616)
7    Sec. 4. Classes of insurance. Insurance and insurance
8business shall be classified as follows:
9    Class 1. Life, Accident and Health.
10    (a) Life. Insurance on the lives of persons and every
11insurance appertaining thereto or connected therewith and
12granting, purchasing or disposing of annuities. Policies of
13life or endowment insurance or annuity contracts or contracts
14supplemental thereto which contain provisions for additional
15benefits in case of death by accidental means and provisions
16operating to safeguard such policies or contracts against
17lapse, to give a special surrender value, or special benefit,
18or an annuity, in the event, that the insured or annuitant
19shall become a person with a total and permanent disability as
20defined by the policy or contract, or which contain benefits
21providing acceleration of life or endowment or annuity
22benefits in advance of the time they would otherwise be
23payable, as an indemnity for long term care which is certified
24or ordered by a physician, including but not limited to,

 

 

HB5493 Enrolled- 10 -LRB103 39189 RPS 69335 b

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

 

 

HB5493 Enrolled- 11 -LRB103 39189 RPS 69335 b

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

 

 

HB5493 Enrolled- 12 -LRB103 39189 RPS 69335 b

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

 

 

HB5493 Enrolled- 13 -LRB103 39189 RPS 69335 b

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

 

 

HB5493 Enrolled- 14 -LRB103 39189 RPS 69335 b

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

 

 

HB5493 Enrolled- 15 -LRB103 39189 RPS 69335 b

1        (ii) plans owned or operated by attorneys who are the
2    providers of legal services to the plan;
3        (iii) plans providing legal service benefits to groups
4    where such plans are owned or operated by authority of a
5    state, county, local or other bar association;
6        (iv) any lawyer referral service authorized or
7    operated by a state, county, local or other bar
8    association;
9        (v) the furnishing of legal assistance by labor unions
10    and other employee organizations to their members in
11    matters relating to employment or occupation;
12        (vi) the furnishing of legal assistance to members or
13    dependents, by churches, consumer organizations,
14    cooperatives, educational institutions, credit unions, or
15    organizations of employees, where such organizations
16    contract directly with lawyers or law firms for the
17    provision of legal services, and the administration and
18    marketing of such legal services is wholly conducted by
19    the organization or its subsidiary;
20        (vii) legal services provided by an employee welfare
21    benefit plan defined by the Employee Retirement Income
22    Security Act of 1974;
23        (viii) any collectively bargained plan for legal
24    services between a labor union and an employer negotiated
25    pursuant to Section 302 of the Labor Management Relations
26    Act as now or hereafter amended, under which plan legal

 

 

HB5493 Enrolled- 16 -LRB103 39189 RPS 69335 b

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

 

 

HB5493 Enrolled- 17 -LRB103 39189 RPS 69335 b

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

 

 

HB5493 Enrolled- 18 -LRB103 39189 RPS 69335 b

1be known as surety business.
2    (h) Miscellaneous. Insurance against loss or damage to
3property and any liability of the insured caused by accidents
4to boilers, pipes, pressure containers, machinery and
5apparatus of any kind and any apparatus connected thereto, or
6used for creating, transmitting or applying power, light,
7heat, steam or refrigeration, making inspection of and issuing
8certificates of inspection upon elevators, boilers, machinery
9and apparatus of any kind and all mechanical apparatus and
10appliances appertaining thereto; insurance against loss or
11damage by water entering through leaks or openings in
12buildings, or from the breakage or leakage of a sprinkler,
13pumps, water pipes, plumbing and all tanks, apparatus,
14conduits and containers designed to bring water into buildings
15or for its storage or utilization therein, or caused by the
16falling of a tank, tank platform or supports, or against loss
17or damage from any cause (other than causes specifically
18enumerated under Class 3 of this Section) to such sprinkler,
19pumps, water pipes, plumbing, tanks, apparatus, conduits or
20containers; insurance against loss or damage which may result
21from the failure of debtors to pay their obligations to the
22insured; and insurance of the payment of money for personal
23services under contracts of hiring.
24    (i) Other casualty risks. Insurance against any other
25casualty risk not otherwise specified under Classes 1 or 3,
26which may lawfully be the subject of insurance and may

 

 

HB5493 Enrolled- 19 -LRB103 39189 RPS 69335 b

1properly be classified under Class 2.
2    (j) Contingent losses. Contingent, consequential and
3indirect coverages wherein the proximate cause of the loss is
4attributable to any one of the causes enumerated under Class
52. Such coverages shall, for the purpose of classification, be
6included in the specific grouping of the kinds of insurance
7wherein such cause is specified.
8    (k) Livestock and domestic animals. Insurance against
9mortality, accident and health of livestock and domestic
10animals.
11    (l) Legal expense insurance. Insurance against risk
12resulting from the cost of legal services as defined under
13Class 1(c).
14    Class 3. Fire and Marine, etc.
15    (a) Fire. Insurance against loss or damage by fire, smoke
16and smudge, lightning or other electrical disturbances.
17    (b) Elements. Insurance against loss or damage by
18earthquake, windstorms, cyclone, tornado, tempests, hail,
19frost, snow, ice, sleet, flood, rain, drought or other weather
20or climatic conditions including excess or deficiency of
21moisture, rising of the waters of the ocean or its
22tributaries.
23    (c) War, riot and explosion. Insurance against loss or
24damage by bombardment, invasion, insurrection, riot, strikes,
25civil war or commotion, military or usurped power, or
26explosion (other than explosion of steam boilers and the

 

 

HB5493 Enrolled- 20 -LRB103 39189 RPS 69335 b

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

 

 

HB5493 Enrolled- 21 -LRB103 39189 RPS 69335 b

1loss by reason of bodily injury to the person; and insurance
2against loss or damage to precious stones, jewels, jewelry,
3gold, silver and other precious metals whether used in
4business or trade or otherwise and whether the same be in
5course of transportation or otherwise, which shall include
6jewelers' block insurance; and insurance against loss or
7damage to bridges, tunnels and other instrumentalities of
8transportation and communication (excluding buildings, their
9furniture and furnishings, fixed contents and supplies held in
10storage) unless fire, tornado, sprinkler leakage, hail,
11explosion, earthquake, riot and civil commotion are the only
12hazards to be covered; and to piers, wharves, docks and slips,
13excluding the risks of fire, tornado, sprinkler leakage, hail,
14explosion, earthquake, riot and civil commotion; and to other
15aids to navigation and transportation, including dry docks and
16marine railways, against all risk.
17    (e) Vehicle. Insurance against loss or liability resulting
18from or incident to the ownership, maintenance or use of any
19vehicle (motor or otherwise), draft animal or aircraft,
20excluding the liability of the insured for the death, injury
21or disability of another person.
22    (f) Property damage, sprinkler leakage and crop. Insurance
23against the liability of the insured for loss or damage to
24another person's property or property interests from any cause
25enumerated in this class; insurance against loss or damage by
26water entering through leaks or openings in buildings, or from

 

 

HB5493 Enrolled- 22 -LRB103 39189 RPS 69335 b

1the breakage or leakage of a sprinkler, pumps, water pipes,
2plumbing and all tanks, apparatus, conduits and containers
3designed to bring water into buildings or for its storage or
4utilization therein, or caused by the falling of a tank, tank
5platform or supports or against loss or damage from any cause
6to such sprinklers, pumps, water pipes, plumbing, tanks,
7apparatus, conduits or containers; insurance against loss or
8damage from insects, diseases or other causes to trees, crops
9or other products of the soil.
10    (g) Other fire and marine risks. Insurance against any
11other property risk not otherwise specified under Classes 1 or
122, which may lawfully be the subject of insurance and may
13properly be classified under Class 3.
14    (h) Contingent losses. Contingent, consequential and
15indirect coverages wherein the proximate cause of the loss is
16attributable to any of the causes enumerated under Class 3.
17Such coverages shall, for the purpose of classification, be
18included in the specific grouping of the kinds of insurance
19wherein such cause is specified.
20    (i) Legal expense insurance. Insurance against risk
21resulting from the cost of legal services as defined under
22Class 1(c).
23(Source: P.A. 101-81, eff. 7-12-19.)
 
24    (215 ILCS 5/352)  (from Ch. 73, par. 964)
25    Sec. 352. Scope of Article.

 

 

HB5493 Enrolled- 23 -LRB103 39189 RPS 69335 b

1    (a) Except as provided in subsections (b), (c), (d), and
2(e), and (g), this Article shall apply to all companies
3transacting in this State the kinds of business enumerated in
4clause (b) of Class 1 and clause (a) of Class 2 of Section 4
5and to all policies, contracts, and certificates of insurance
6issued in connection therewith that are not otherwise excluded
7under Article VII of this Code. Nothing in this Article shall
8apply to, or in any way affect policies or contracts described
9in clause (a) of Class 1 of Section 4; however, this Article
10shall apply to policies and contracts which contain benefits
11providing reimbursement for the expenses of long term health
12care which are certified or ordered by a physician including
13but not limited to professional nursing care, custodial
14nursing care, and non-nursing custodial care provided in a
15nursing home or at a residence of the insured.
16    (b) (Blank).
17    (c) A policy issued and delivered in this State that
18provides coverage under that policy for certificate holders
19who are neither residents of nor employed in this State does
20not need to provide to those nonresident certificate holders
21who are not employed in this State the coverages or services
22mandated by this Article.
23    (d) Stop-loss insurance, as defined in clause (b) of Class
241 or clause (a) of Class 2 of Section 4, is exempt from all
25Sections of this Article, except this Section and Sections
26353a, 354, 357.30, and 370. For purposes of this exemption,

 

 

HB5493 Enrolled- 24 -LRB103 39189 RPS 69335 b

1stop-loss insurance is further defined as follows:
2        (1) The policy must be issued to and insure an
3    employer, trustee, or other sponsor of the plan, or the
4    plan itself, but not employees, members, or participants.
5        (2) Payments by the insurer must be made to the
6    employer, trustee, or other sponsors of the plan, or the
7    plan itself, but not to the employees, members,
8    participants, or health care providers.
9    (e) A policy issued or delivered in this State to the
10Department of Healthcare and Family Services (formerly
11Illinois Department of Public Aid) and providing coverage,
12under clause (b) of Class 1 or clause (a) of Class 2 as
13described in Section 4, to persons who are enrolled under
14Article V of the Illinois Public Aid Code or under the
15Children's Health Insurance Program Act is exempt from all
16restrictions, limitations, standards, rules, or regulations
17respecting benefits imposed by or under authority of this
18Code, except those specified by subsection (1) of Section 143,
19Section 370c, and Section 370c.1. Nothing in this subsection,
20however, affects the total medical services available to
21persons eligible for medical assistance under the Illinois
22Public Aid Code.
23    (f) An in-office membership care agreement provided under
24the In-Office Membership Care Act is not insurance for the
25purposes of this Code.
26    (g) The provisions of Sections 356a through 359a, both

 

 

HB5493 Enrolled- 25 -LRB103 39189 RPS 69335 b

1inclusive, shall not apply to or affect:
2        (1) any policy or contract of reinsurance; or
3        (2) life insurance, endowment or annuity contracts, or
4    contracts supplemental thereto that contain only such
5    provisions relating to accident and sickness insurance
6    that (A) provide additional benefits in case of death or
7    dismemberment or loss of sight by accident, or (B) operate
8    to safeguard such contracts against lapse, or to give a
9    special surrender value or special benefit or an annuity
10    if the insured or annuitant becomes a person with a total
11    and permanent disability, as defined by the contract or
12    supplemental contract.
13(Source: P.A. 101-190, eff. 8-2-19.)
 
14    (215 ILCS 5/352b)
15    Sec. 352b. Excepted benefits exempted Policy of individual
16or group accident and health insurance.
17    (a) Unless specified otherwise and when used in context of
18accident and health insurance policy benefits, coverage,
19terms, or conditions required to be provided under this
20Article, references to any "policy of individual or group
21accident and health insurance", or both, as used in this
22Article, do does not include any coverage or policy that
23provides an excepted benefit, as that term is defined in
24Section 2791(c) of the federal Public Health Service Act (42
25U.S.C. 300gg-91). Nothing in this subsection amendatory Act of

 

 

HB5493 Enrolled- 26 -LRB103 39189 RPS 69335 b

1the 101st General Assembly applies to a policy of liability,
2workers' compensation, automobile medical payment, or limited
3scope dental or vision benefits insurance issued under this
4Code. Nothing in this subsection shall be construed to subject
5excepted benefits outside the scope of Section 352 to any
6requirements of this Article.
7    (b) Nothing in this Article shall require a policy of
8excepted benefits to provide benefits, coverage, terms, or
9conditions in such a manner as to disqualify it from being
10classified under federal law as the type of excepted benefit
11for which its policy forms are filed under Sections 143 and 355
12of this Code.
13(Source: P.A. 101-456, eff. 8-23-19.)
 
14    (215 ILCS 5/356a)  (from Ch. 73, par. 968a)
15    Sec. 356a. Form of policy.
16    (1) No individual policy of accident and health insurance
17shall be delivered or issued for delivery to any person in this
18State state unless:
19        (a) the entire money and other considerations therefor
20    are expressed therein; and
21        (b) the time at which the insurance takes effect and
22    terminates is expressed therein; and
23        (c) it purports to insure only one person, except that
24    a policy may insure, originally or by subsequent
25    amendment, upon the application of an adult member of a

 

 

HB5493 Enrolled- 27 -LRB103 39189 RPS 69335 b

1    family who shall be deemed the policyholder, any 2 two or
2    more eligible members of that family, including husband,
3    wife, dependent children or any children under a specified
4    age which shall not exceed 19 years and any other person
5    dependent upon the policyholder; and
6        (d) the style, arrangement and over-all appearance of
7    the policy give no undue prominence to any portion of the
8    text, and unless every printed portion of the text of the
9    policy and of any endorsements or attached papers is
10    plainly printed in light-faced type of a style in general
11    use, the size of which shall be uniform and not less than
12    ten-point with a lower-case unspaced alphabet length not
13    less than one hundred and twenty-point (the "text" shall
14    include all printed matter except the name and address of
15    the insurer, name or title of the policy, the brief
16    description if any, and captions and subcaptions); and
17        (e) the exceptions and reductions of indemnity are set
18    forth in the policy and, except those which are set forth
19    in Sections 357.1 through 357.30 of this act, are printed,
20    at the insurer's option, either included with the benefit
21    provision to which they apply, or under an appropriate
22    caption such as "EXCEPTIONS", or "EXCEPTIONS AND
23    REDUCTIONS", provided that if an exception or reduction
24    specifically applies only to a particular benefit of the
25    policy, a statement of such exception or reduction shall
26    be included with the benefit provision to which it

 

 

HB5493 Enrolled- 28 -LRB103 39189 RPS 69335 b

1    applies; and
2        (f) each such form, including riders and endorsements,
3    shall be identified by a form number in the lower
4    left-hand corner of the first page thereof; and
5        (g) it contains no provision purporting to make any
6    portion of the charter, rules, constitution, or by-laws of
7    the insurer a part of the policy unless such portion is set
8    forth in full in the policy, except in the case of the
9    incorporation of, or reference to, a statement of rates or
10    classification of risks, or short-rate table filed with
11    the Director.
12    (2) If any policy is issued by an insurer domiciled in this
13state for delivery to a person residing in another state, and
14if the official having responsibility for the administration
15of the insurance laws of such other state shall have advised
16the Director that any such policy is not subject to approval or
17disapproval by such official, the Director may by ruling
18require that such policy meet the standards set forth in
19subsection (1) of this section and in Sections 357.1 through
20357.30.
21(Source: P.A. 76-860.)
 
22    (215 ILCS 5/356b)  (from Ch. 73, par. 968b)
23    Sec. 356b. (a) This Section applies to the hospital and
24medical expense provisions of an individual accident or health
25insurance policy.

 

 

HB5493 Enrolled- 29 -LRB103 39189 RPS 69335 b

1    (b) If a policy provides that coverage of a dependent
2person terminates upon attainment of the limiting age for
3dependent persons specified in the policy, the attainment of
4such limiting age does not operate to terminate the hospital
5and medical coverage of a person who, because of a disabling
6condition that occurred before attainment of the limiting age,
7is incapable of self-sustaining employment and is dependent on
8his or her parents or other care providers for lifetime care
9and supervision.
10    (c) For purposes of subsection (b), "dependent on other
11care providers" is defined as requiring a Community Integrated
12Living Arrangement, group home, supervised apartment, or other
13residential services licensed or certified by the Department
14of Human Services (as successor to the Department of Mental
15Health and Developmental Disabilities), the Department of
16Public Health, or the Department of Healthcare and Family
17Services (formerly Department of Public Aid).
18    (d) The insurer may inquire of the policyholder 2 months
19prior to attainment by a dependent of the limiting age set
20forth in the policy, or at any reasonable time thereafter,
21whether such dependent is in fact a person who has a disability
22and is dependent and, in the absence of proof submitted within
2360 days of such inquiry that such dependent is a person who has
24a disability and is dependent may terminate coverage of such
25person at or after attainment of the limiting age. In the
26absence of such inquiry, coverage of any person who has a

 

 

HB5493 Enrolled- 30 -LRB103 39189 RPS 69335 b

1disability and is dependent shall continue through the term of
2such policy or any extension or renewal thereof.
3    (e) This amendatory Act of 1969 is applicable to policies
4issued or renewed more than 60 days after the effective date of
5this amendatory Act of 1969.
6(Source: P.A. 99-143, eff. 7-27-15.)
 
7    (215 ILCS 5/356d)  (from Ch. 73, par. 968d)
8    Sec. 356d. Conversion privileges for insured former
9spouses. (1) No individual policy of accident and health
10insurance providing coverage of hospital and/or medical
11expense on either an expense incurred basis or other than an
12expense incurred basis, which in addition to covering the
13insured also provides coverage to the spouse of the insured
14shall contain a provision for termination of coverage for a
15spouse covered under the policy solely as a result of a break
16in the marital relationship except by reason of an entry of a
17valid judgment of dissolution of marriage between the parties.
18    (2) Every policy which contains a provision for
19termination of coverage of the spouse upon dissolution of
20marriage shall contain a provision to the effect that upon the
21entry of a valid judgment of dissolution of marriage between
22the insured parties the spouse whose marriage was dissolved
23shall be entitled to have issued to him or her, without
24evidence of insurability, upon application made to the company
25within 60 days following the entry of such judgment, and upon

 

 

HB5493 Enrolled- 31 -LRB103 39189 RPS 69335 b

1the payment of the appropriate premium, an individual policy
2of accident and health insurance. Such policy shall provide
3the coverage then being issued by the insurer which is most
4nearly similar to, but not greater than, such terminated
5coverages. Any and all probationary and/or waiting periods set
6forth in such policy shall be considered as being met to the
7extent coverage was in force under the prior policy.
8    (3) The requirements of this Section shall apply to all
9policies delivered or issued for delivery on or after the 60th
10day following the effective date of this Section.
11(Source: P.A. 84-545.)
 
12    (215 ILCS 5/356e)  (from Ch. 73, par. 968e)
13    Sec. 356e. Victims of certain offenses.
14    (1) No individual policy of accident and health insurance,
15which provides benefits for hospital or medical expenses based
16upon the actual expenses incurred, delivered or issued for
17delivery to any person in this State shall contain any
18specific exception to coverage which would preclude the
19payment under that policy of actual expenses incurred in the
20examination and testing of a victim of an offense defined in
21Sections 11-1.20 through 11-1.60 or 12-13 through 12-16 of the
22Criminal Code of 1961 or the Criminal Code of 2012, or an
23attempt to commit such offense to establish that sexual
24contact did occur or did not occur, and to establish the
25presence or absence of sexually transmitted disease or

 

 

HB5493 Enrolled- 32 -LRB103 39189 RPS 69335 b

1infection, and examination and treatment of injuries and
2trauma sustained by a victim of such offense arising out of the
3offense. Every policy of accident and health insurance which
4specifically provides benefits for routine physical
5examinations shall provide full coverage for expenses incurred
6in the examination and testing of a victim of an offense
7defined in Sections 11-1.20 through 11-1.60 or 12-13 through
812-16 of the Criminal Code of 1961 or the Criminal Code of
92012, or an attempt to commit such offense as set forth in this
10Section. This Section shall not apply to a policy which covers
11hospital and medical expenses for specified illnesses or
12injuries only.
13    (2) For purposes of enabling the recovery of State funds,
14any insurance carrier subject to this Section shall upon
15reasonable demand by the Department of Public Health disclose
16the names and identities of its insureds entitled to benefits
17under this provision to the Department of Public Health
18whenever the Department of Public Health has determined that
19it has paid, or is about to pay, hospital or medical expenses
20for which an insurance carrier is liable under this Section.
21All information received by the Department of Public Health
22under this provision shall be held on a confidential basis and
23shall not be subject to subpoena and shall not be made public
24by the Department of Public Health or used for any purpose
25other than that authorized by this Section.
26    (3) Whenever the Department of Public Health finds that it

 

 

HB5493 Enrolled- 33 -LRB103 39189 RPS 69335 b

1has paid all or part of any hospital or medical expenses which
2an insurance carrier is obligated to pay under this Section,
3the Department of Public Health shall be entitled to receive
4reimbursement for its payments from such insurance carrier
5provided that the Department of Public Health has notified the
6insurance carrier of its claims before the carrier has paid
7such benefits to its insureds or in behalf of its insureds.
8(Source: P.A. 96-1551, eff. 7-1-11; 97-1150, eff. 1-25-13.)
 
9    (215 ILCS 5/356f)  (from Ch. 73, par. 968f)
10    Sec. 356f. No individual policy of accident or health
11insurance or any renewal thereof shall be denied or cancelled
12by the insurer, nor shall any such policy contain any
13exception or exclusion of benefits, solely because the mother
14of the insured has taken diethylstilbestrol, commonly referred
15to as DES.
16(Source: P.A. 81-656.)
 
17    (215 ILCS 5/356K)  (from Ch. 73, par. 968K)
18    Sec. 356K. Coverage for Organ Transplantation Procedures.
19No accident and health insurer providing individual accident
20and health insurance coverage under this Act for hospital or
21medical expenses shall deny reimbursement for an otherwise
22covered expense incurred for any organ transplantation
23procedure solely on the basis that such procedure is deemed
24experimental or investigational unless supported by the

 

 

HB5493 Enrolled- 34 -LRB103 39189 RPS 69335 b

1determination of the Office of Health Care Technology
2Assessment within the Agency for Health Care Policy and
3Research within the federal Department of Health and Human
4Services that such procedure is either experimental or
5investigational or that there is insufficient data or
6experience to determine whether an organ transplantation
7procedure is clinically acceptable. If an accident and health
8insurer has made written request, or had one made on its behalf
9by a national organization, for determination by the Office of
10Health Care Technology Assessment within the Agency for Health
11Care Policy and Research within the federal Department of
12Health and Human Services as to whether a specific organ
13transplantation procedure is clinically acceptable and said
14organization fails to respond to such a request within a
15period of 90 days, the failure to act may be deemed a
16determination that the procedure is deemed to be experimental
17or investigational.
18(Source: P.A. 87-218.)
 
19    (215 ILCS 5/356L)  (from Ch. 73, par. 968L)
20    Sec. 356L. No individual policy of accident or health
21insurance shall include any provision which shall have the
22effect of denying coverage to or on behalf of an insured under
23such policy on the basis of a failure by the insured to file a
24notice of claim within the time period required by the policy,
25provided such failure is caused solely by the physical

 

 

HB5493 Enrolled- 35 -LRB103 39189 RPS 69335 b

1inability or mental incapacity of the insured to file such
2notice of claim because of a period of emergency
3hospitalization.
4(Source: P.A. 86-784.)
 
5    (215 ILCS 5/356r)
6    Sec. 356r. Access to obstetrical and gynecological care
7Woman's principal health care provider.
8    (a) An individual or group policy of accident and health
9insurance or a managed care plan amended, delivered, issued,
10or renewed in this State must not require authorization or
11referral by the plan, issuer, or any person, including a
12primary care provider, for any covered individual who seeks
13coverage for obstetrical or gynecological care provided by any
14licensed or certified participating health care professional
15who specializes in obstetrics or gynecology. after November
1614, 1996 that requires an insured or enrollee to designate an
17individual to coordinate care or to control access to health
18care services shall also permit a female insured or enrollee
19to designate a participating woman's principal health care
20provider, and the insurer or managed care plan shall provide
21the following written notice to all female insureds or
22enrollees no later than 120 days after the effective date of
23this amendatory Act of 1998; to all new enrollees at the time
24of enrollment; and thereafter to all existing enrollees at
25least annually, as a part of a regular publication or

 

 

HB5493 Enrolled- 36 -LRB103 39189 RPS 69335 b

1informational mailing:
2
"NOTICE TO ALL FEMALE PLAN MEMBERS:
3
YOUR RIGHT TO SELECT A WOMAN'S PRINCIPAL
4
HEALTH CARE PROVIDER.
5        Illinois law allows you to select "a woman's principal
6    health care provider" in addition to your selection of a
7    primary care physician. A woman's principal health care
8    provider is a physician licensed to practice medicine in
9    all its branches specializing in obstetrics or gynecology
10    or specializing in family practice. A woman's principal
11    health care provider may be seen for care without
12    referrals from your primary care physician. If you have
13    not already selected a woman's principal health care
14    provider, you may do so now or at any other time. You are
15    not required to have or to select a woman's principal
16    health care provider.
17        Your woman's principal health care provider must be a
18    part of your plan. You may get the list of participating
19    obstetricians, gynecologists, and family practice
20    specialists from your employer's employee benefits
21    coordinator, or for your own copy of the current list, you
22    may call [insert plan's toll free number]. The list will
23    be sent to you within 10 days after your call. To designate
24    a woman's principal health care provider from the list,
25    call [insert plan's toll free number] and tell our staff
26    the name of the physician you have selected.".

 

 

HB5493 Enrolled- 37 -LRB103 39189 RPS 69335 b

1If the insurer or managed care plan exercises the option set
2forth in subsection (a-5), the notice shall also state:
3        "Your plan requires that your primary care physician
4    and your woman's principal health care provider have a
5    referral arrangement with one another. If the woman's
6    principal health care provider that you select does not
7    have a referral arrangement with your primary care
8    physician, you will have to select a new primary care
9    physician who has a referral arrangement with your woman's
10    principal health care provider or you may select a woman's
11    principal health care provider who has a referral
12    arrangement with your primary care physician. The list of
13    woman's principal health care providers will also have the
14    names of the primary care physicians and their referral
15    arrangements.".
16    No later than 120 days after the effective date of this
17amendatory Act of 1998, the insurer or managed care plan shall
18provide each employer who has a policy of insurance or a
19managed care plan with the insurer or managed care plan with a
20list of physicians licensed to practice medicine in all its
21branches specializing in obstetrics or gynecology or
22specializing in family practice who have contracted with the
23plan. At the time of enrollment and thereafter within 10 days
24after a request by an insured or enrollee, the insurer or
25managed care plan also shall provide this list directly to the
26insured or enrollee. The list shall include each physician's

 

 

HB5493 Enrolled- 38 -LRB103 39189 RPS 69335 b

1address, telephone number, and specialty. No insurer or plan
2formal or informal policy may restrict a female insured's or
3enrollee's right to designate a woman's principal health care
4provider, except as set forth in subsection (a-5). If the
5female enrollee is an enrollee of a managed care plan under
6contract with the Department of Healthcare and Family
7Services, the physician chosen by the enrollee as her woman's
8principal health care provider must be a Medicaid-enrolled
9provider. This requirement does not require a female insured
10or enrollee to make a selection of a woman's principal health
11care provider. The female insured or enrollee may designate a
12physician licensed to practice medicine in all its branches
13specializing in family practice as her woman's principal
14health care provider.
15    (a-5) If a policy, contract, or certificate requires or
16allows a covered individual to designate a primary care
17provider and provides coverage for any obstetrical or
18gynecological care, the insurer shall provide the notice
19required under 45 CFR 147.138(a)(4) and 149.310(a)(4) in all
20circumstances required under that provision. The insured or
21enrollee may be required by the insurer or managed care plan to
22select a woman's principal health care provider who has a
23referral arrangement with the insured's or enrollee's
24individual who coordinates care or controls access to health
25care services if such referral arrangement exists or to select
26a new individual to coordinate care or to control access to

 

 

HB5493 Enrolled- 39 -LRB103 39189 RPS 69335 b

1health care services who has a referral arrangement with the
2woman's principal health care provider chosen by the insured
3or enrollee, if such referral arrangement exists. If an
4insurer or a managed care plan requires an insured or enrollee
5to select a new physician under this subsection (a-5), the
6insurer or managed care plan must provide the insured or
7enrollee with both options to select a new physician provided
8in this subsection (a-5).
9    Notwithstanding a plan's restrictions of the frequency or
10timing of making designations of primary care providers, a
11female enrollee or insured who is subject to the selection
12requirements of this subsection, may, at any time, effect a
13change in primary care physicians in order to make a selection
14of a woman's principal health care provider.
15    (a-6) The requirements of this Section shall be construed
16in a manner consistent with the requirements for access to and
17notice of obstetrical and gynecological care in 45 CFR 147.138
18and 45 CFR 149.310. If an insurer or managed care plan
19exercises the option in subsection (a-5), the list to be
20provided under subsection (a) shall identify the referral
21arrangements that exist between the individual who coordinates
22care or controls access to health care services and the
23woman's principal health care provider in order to assist the
24female insured or enrollee to make a selection within the
25insurer's or managed care plan's requirement.
26    (b) Nothing in this Section prevents a health insurance

 

 

HB5493 Enrolled- 40 -LRB103 39189 RPS 69335 b

1issuer from requiring a participating obstetrical or
2gynecological health care professional to agree, with respect
3to individuals covered under a policy of accident and health
4insurance, to otherwise adhere to the health insurance
5issuer's policies and procedures, including procedures
6regarding referrals and obtaining prior authorization and
7providing services pursuant to a treatment plan, if any,
8approved by the issuer. If a female insured or enrollee has
9designated a woman's principal health care provider, then the
10insured or enrollee must be given direct access to the woman's
11principal health care provider for services covered by the
12policy or plan without the need for a referral or prior
13approval. Nothing shall prohibit the insurer or managed care
14plan from requiring prior authorization or approval from
15either a primary care provider or the woman's principal health
16care provider for referrals for additional care or services.
17    (c) (Blank). For the purposes of this Section the
18following terms are defined:
19        (1) "Woman's principal health care provider" means a
20    physician licensed to practice medicine in all of its
21    branches specializing in obstetrics or gynecology or
22    specializing in family practice.
23        (2) "Managed care entity" means any entity including a
24    licensed insurance company, hospital or medical service
25    plan, health maintenance organization, limited health
26    service organization, preferred provider organization,

 

 

HB5493 Enrolled- 41 -LRB103 39189 RPS 69335 b

1    third party administrator, an employer or employee
2    organization, or any person or entity that establishes,
3    operates, or maintains a network of participating
4    providers.
5        (3) "Managed care plan" means a plan operated by a
6    managed care entity that provides for the financing of
7    health care services to persons enrolled in the plan
8    through:
9            (A) organizational arrangements for ongoing
10        quality assurance, utilization review programs, or
11        dispute resolution; or
12            (B) financial incentives for persons enrolled in
13        the plan to use the participating providers and
14        procedures covered by the plan.
15        (4) "Participating provider" means a physician who has
16    contracted with an insurer or managed care plan to provide
17    services to insureds or enrollees as defined by the
18    contract.
19    (d) Nothing in this Section shall be construed to preclude
20a health insurance issuer from requiring that a participating
21obstetrical or gynecological health care professional notify
22the covered individual's primary care physician or the issuer
23of treatment decisions or update centralized medical records.
24The original provisions of this Section became law on July 17,
251996 and took effect November 14, 1996, which is 120 days after
26becoming law.

 

 

HB5493 Enrolled- 42 -LRB103 39189 RPS 69335 b

1(Source: P.A. 95-331, eff. 8-21-07.)
 
2    (215 ILCS 5/356s)
3    Sec. 356s. Post-parturition care. An individual or group
4policy of accident and health insurance that provides
5maternity coverage and is amended, delivered, issued, or
6renewed after the effective date of this amendatory Act of
71996 shall provide coverage for the following:
8        (1) a minimum of 48 hours of inpatient care following
9    a vaginal delivery for the mother and the newborn, except
10    as otherwise provided in this Section; or
11        (2) a minimum of 96 hours of inpatient care following
12    a delivery by caesarian section for the mother and
13    newborn, except as otherwise provided in this Section.
14    Coverage may be limited to a A shorter length of hospital
15inpatient care stay for services related to maternity and
16newborn care may be provided if the attending physician
17licensed to practice medicine in all of its branches
18determines, in accordance with the protocols and guidelines
19developed by the American College of Obstetricians and
20Gynecologists or the American Academy of Pediatrics, that the
21mother and the newborn meet the appropriate guidelines for
22that length of stay based upon evaluation of the mother and
23newborn and the coverage and availability of a post-discharge
24physician office visit or in-home nurse visit to verify the
25condition of the infant in the first 48 hours after discharge.

 

 

HB5493 Enrolled- 43 -LRB103 39189 RPS 69335 b

1(Source: P.A. 89-513, eff. 9-15-96; 90-14, eff. 7-1-97.)
 
2    (215 ILCS 5/356z.3)
3    Sec. 356z.3. Disclosure of limited benefit. An insurer
4that issues, delivers, amends, or renews an individual or
5group policy of accident and health insurance in this State
6after the effective date of this amendatory Act of the 92nd
7General Assembly and arranges, contracts with, or administers
8contracts with a provider whereby beneficiaries are provided
9an incentive to use the services of such provider must include
10the following disclosure on its contracts and evidences of
11coverage: "WARNING, LIMITED BENEFITS WILL BE PAID WHEN
12NON-PARTICIPATING PROVIDERS ARE USED. YOU CAN EXPECT TO PAY
13MORE THAN THE COST-SHARING AMOUNT DEFINED IN THE POLICY IN
14NON-EMERGENCY SITUATIONS. Except in limited situations
15governed by the federal No Surprises Act or Section 356z.3a of
16the Illinois Insurance Code (215 ILCS 5/356z.3a),
17non-participating providers furnishing non-emergency services
18may bill members for any amount up to the billed charge after
19the plan has paid its portion of the bill. If you elect to use
20a non-participating provider, plan benefit payments will be
21determined according to your policy's fee schedule, usual and
22customary charge (which is determined by comparing charges for
23similar services adjusted to the geographical area where the
24services are performed), or other method as defined by the
25policy. Participating providers have agreed to ONLY bill

 

 

HB5493 Enrolled- 44 -LRB103 39189 RPS 69335 b

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

 

 

HB5493 Enrolled- 45 -LRB103 39189 RPS 69335 b

1participating status of professional providers and information
2on out-of-pocket expenses by calling the toll-free toll free
3telephone number on your identification card.".
4(Source: P.A. 102-901, eff. 1-1-23.)
 
5    (215 ILCS 5/356z.33)
6    (Text of Section before amendment by P.A. 103-454)
7    Sec. 356z.33. Coverage for epinephrine injectors. A group
8or individual policy of accident and health insurance or a
9managed care plan that is amended, delivered, issued, or
10renewed on or after January 1, 2020 (the effective date of
11Public Act 101-281) shall provide coverage for medically
12necessary epinephrine injectors for persons 18 years of age or
13under. As used in this Section, "epinephrine injector" has the
14meaning given to that term in Section 5 of the Epinephrine
15Injector Act.
16(Source: P.A. 101-281, eff. 1-1-20; 102-558, eff. 8-20-21.)
 
17    (Text of Section after amendment by P.A. 103-454)
18    Sec. 356z.33. Coverage for epinephrine injectors.
19    (a) A group or individual policy of accident and health
20insurance or a managed care plan that is amended, delivered,
21issued, or renewed on or after January 1, 2020 (the effective
22date of Public Act 101-281) shall provide coverage for
23medically necessary epinephrine injectors for persons 18 years
24of age or under. As used in this Section, "epinephrine

 

 

HB5493 Enrolled- 46 -LRB103 39189 RPS 69335 b

1injector" has the meaning given to that term in Section 5 of
2the Epinephrine Injector Act.
3    (b) An insurer that provides coverage for medically
4necessary epinephrine injectors shall limit the total amount
5that an insured is required to pay for a twin-pack of medically
6necessary epinephrine injectors at an amount not to exceed
7$60, regardless of the type of epinephrine injector; except
8that this provision does not apply to the extent such coverage
9would disqualify a high-deductible health plan from
10eligibility for a health savings account pursuant to Section
11223 of the Internal Revenue Code (26 U.S.C. 223).
12    (c) Nothing in this Section prevents an insurer from
13reducing an insured's cost sharing by an amount greater than
14the amount specified in subsection (b).
15    (d) The Department may adopt rules as necessary to
16implement and administer this Section.
17(Source: P.A. 102-558, eff. 8-20-21; 103-454, eff. 1-1-25.)
 
18    (215 ILCS 5/367a)  (from Ch. 73, par. 979a)
19    Sec. 367a. Blanket accident and health insurance.
20    (1) Blanket accident and health insurance is that form of
21accident and health insurance covering special groups of
22persons as enumerated in one of the following paragraphs (a)
23to (g), inclusive:
24        (a) Under a policy or contract issued to any carrier
25    for hire, which shall be deemed the policyholder, covering

 

 

HB5493 Enrolled- 47 -LRB103 39189 RPS 69335 b

1    a group defined as all persons who may become passengers
2    on such carrier.
3        (b) Under a policy or contract issued to an employer,
4    who shall be deemed the policyholder, covering all
5    employees or any group of employees defined by reference
6    to exceptional hazards incident to such employment.
7        (c) Under a policy or contract issued to a college,
8    school, or other institution of learning or to the head or
9    principal thereof, who or which shall be deemed the
10    policyholder, covering students or teachers. However,
11    student health insurance coverage, as defined in 45 CFR
12    147.145, shall remain subject to the standards and
13    requirements for individual health insurance coverage
14    except where inconsistent with that regulation. Student
15    health insurance coverage shall not be subject to the
16    Short-Term, Limited-Duration Health Insurance Coverage
17    Act. An insurer providing student health insurance
18    coverage or a policy or contract covering students for
19    limited-scope dental or vision under 45 CFR 148.220 shall
20    require an individual application or enrollment form and
21    shall furnish each insured individual a certificate, which
22    shall have been approved by the Director under Section
23    355.
24        (d) Under a policy or contract issued in the name of
25    any volunteer fire department, first aid, or other such
26    volunteer group, which shall be deemed the policyholder,

 

 

HB5493 Enrolled- 48 -LRB103 39189 RPS 69335 b

1    covering all of the members of such department or group.
2        (e) Under a policy or contract issued to a creditor,
3    who shall be deemed the policyholder, to insure debtors of
4    the creditors; Provided, however, that in the case of a
5    loan which is subject to the Small Loans Act, no insurance
6    premium or other cost shall be directly or indirectly
7    charged or assessed against, or collected or received from
8    the borrower.
9        (f) Under a policy or contract issued to a sports team
10    or to a camp, which team or camp sponsor shall be deemed
11    the policyholder, covering members or campers.
12        (g) Under a policy or contract issued to any other
13    substantially similar group which, in the discretion of
14    the Director, may be subject to the issuance of a blanket
15    accident and health policy or contract.
16    (2) Any insurance company authorized to write accident and
17health insurance in this state shall have the power to issue
18blanket accident and health insurance. No such blanket policy
19may be issued or delivered in this State unless a copy of the
20form thereof shall have been filed in accordance with Section
21355, and it contains in substance such of those provisions
22contained in Sections 357.1 through 357.30 as may be
23applicable to blanket accident and health insurance and the
24following provisions:
25        (a) A provision that the policy and the application
26    shall constitute the entire contract between the parties,

 

 

HB5493 Enrolled- 49 -LRB103 39189 RPS 69335 b

1    and that all statements made by the policyholder shall, in
2    absence of fraud, be deemed representations and not
3    warranties, and that no such statements shall be used in
4    defense to a claim under the policy, unless it is
5    contained in a written application.
6        (b) A provision that to the group or class thereof
7    originally insured shall be added from time to time all
8    new persons or individuals eligible for coverage.
9    (3) An individual application shall not be required from a
10person covered under a blanket accident or health policy or
11contract, nor shall it be necessary for the insurer to furnish
12each person a certificate.
13    (3.5) Subsection (3) does not apply to major medical
14insurance, or to any excepted benefits or short-term,
15limited-duration health insurance coverage for which an
16insured individual pays premiums or contributions. In those
17cases, the insurer shall require an individual application or
18enrollment form and shall furnish each insured individual a
19certificate, which shall have been approved by the Director
20under Section 355 of this Code.
21    (4) All benefits under any blanket accident and health
22policy shall be payable to the person insured, or to his
23designated beneficiary or beneficiaries, or to his or her
24estate, except that if the person insured be a minor or person
25under legal disability, such benefits may be made payable to
26his or her parent, guardian, or other person actually

 

 

HB5493 Enrolled- 50 -LRB103 39189 RPS 69335 b

1supporting him or her. Provided further, however, that the
2policy may provide that all or any portion of any indemnities
3provided by any such policy on account of hospital, nursing,
4medical or surgical services may, at the insurer's option, be
5paid directly to the hospital or person rendering such
6services; but the policy may not require that the service be
7rendered by a particular hospital or person. Payment so made
8shall discharge the insurer's obligation with respect to the
9amount of insurance so paid.
10    (5) Nothing contained in this section shall be deemed to
11affect the legal liability of policyholders for the death of
12or injury to, any such member of such group.
13(Source: P.A. 83-1362.)
 
14    (215 ILCS 5/370e)  (from Ch. 73, par. 982e)
15    Sec. 370e. Companies which issue group accident and health
16policies or blanket accident and health plans to employer
17groups in this State shall provide the employer with notice of
18termination of a group or blanket accident and health plan
19because of the employer's failure to pay the premium when due.
20The insurance company shall file send a copy of such notice
21with to the Department in an electronic format either through
22the System for Electronic Rate and Form Filing (SERFF) or as
23otherwise prescribed by the Director.
24(Source: P.A. 83-1006.)
 

 

 

HB5493 Enrolled- 51 -LRB103 39189 RPS 69335 b

1    (215 ILCS 5/370i)  (from Ch. 73, par. 982i)
2    Sec. 370i. Policies, agreements or arrangements with
3incentives or limits on reimbursement authorized.
4    (a) Policies, agreements or arrangements issued under this
5Article may not contain terms or conditions that would operate
6unreasonably to restrict the access and availability of health
7care services for the insured.
8    (b) An insurer or administrator may:
9        (1) enter into agreements with certain providers of
10    its choice relating to health care services which may be
11    rendered to insureds or beneficiaries of the insurer or
12    administrator, including agreements relating to the
13    amounts to be charged the insureds or beneficiaries for
14    services rendered;
15        (2) issue or administer programs, policies or
16    subscriber contracts in this State that include incentives
17    for the insured or beneficiary to utilize the services of
18    a provider which has entered into an agreement with the
19    insurer or administrator pursuant to paragraph (1) above.
20    (c) (Blank). After the effective date of this amendatory
21Act of the 92nd General Assembly, any insurer that arranges,
22contracts with, or administers contracts with a provider
23whereby beneficiaries are provided an incentive to use the
24services of such provider must include the following
25disclosure on its contracts and evidences of coverage:
26"WARNING, LIMITED BENEFITS WILL BE PAID WHEN NON-PARTICIPATING

 

 

HB5493 Enrolled- 52 -LRB103 39189 RPS 69335 b

1PROVIDERS ARE USED. You should be aware that when you elect to
2utilize the services of a non-participating provider for a
3covered service in non-emergency situations, benefit payments
4to such non-participating provider are not based upon the
5amount billed. The basis of your benefit payment will be
6determined according to your policy's fee schedule, usual and
7customary charge (which is determined by comparing charges for
8similar services adjusted to the geographical area where the
9services are performed), or other method as defined by the
10policy. YOU CAN EXPECT TO PAY MORE THAN THE COINSURANCE AMOUNT
11DEFINED IN THE POLICY AFTER THE PLAN HAS PAID ITS REQUIRED
12PORTION. Non-participating providers may bill members for any
13amount up to the billed charge after the plan has paid its
14portion of the bill. Participating providers have agreed to
15accept discounted payments for services with no additional
16billing to the member other than co-insurance and deductible
17amounts. You may obtain further information about the
18participating status of professional providers and information
19on out-of-pocket expenses by calling the toll free telephone
20number on your identification card.".
21(Source: P.A. 92-579, eff. 1-1-03.)
 
22    (215 ILCS 5/408)  (from Ch. 73, par. 1020)
23    (Text of Section before amendment by P.A. 103-75)
24    Sec. 408. Fees and charges.
25    (1) The Director shall charge, collect and give proper

 

 

HB5493 Enrolled- 53 -LRB103 39189 RPS 69335 b

1acquittances for the payment of the following fees and
2charges:
3        (a) For filing all documents submitted for the
4    incorporation or organization or certification of a
5    domestic company, except for a fraternal benefit society,
6    $2,000.
7        (b) For filing all documents submitted for the
8    incorporation or organization of a fraternal benefit
9    society, $500.
10        (c) For filing amendments to articles of incorporation
11    and amendments to declaration of organization, except for
12    a fraternal benefit society, a mutual benefit association,
13    a burial society or a farm mutual, $200.
14        (d) For filing amendments to articles of incorporation
15    of a fraternal benefit society, a mutual benefit
16    association or a burial society, $100.
17        (e) For filing amendments to articles of incorporation
18    of a farm mutual, $50.
19        (f) For filing bylaws or amendments thereto, $50.
20        (g) For filing agreement of merger or consolidation:
21            (i) for a domestic company, except for a fraternal
22        benefit society, a mutual benefit association, a
23        burial society, or a farm mutual, $2,000.
24            (ii) for a foreign or alien company, except for a
25        fraternal benefit society, $600.
26            (iii) for a fraternal benefit society, a mutual

 

 

HB5493 Enrolled- 54 -LRB103 39189 RPS 69335 b

1        benefit association, a burial society, or a farm
2        mutual, $200.
3        (h) For filing agreements of reinsurance by a domestic
4    company, $200.
5        (i) For filing all documents submitted by a foreign or
6    alien company to be admitted to transact business or
7    accredited as a reinsurer in this State, except for a
8    fraternal benefit society, $5,000.
9        (j) For filing all documents submitted by a foreign or
10    alien fraternal benefit society to be admitted to transact
11    business in this State, $500.
12        (k) For filing declaration of withdrawal of a foreign
13    or alien company, $50.
14        (l) For filing annual statement by a domestic company,
15    except a fraternal benefit society, a mutual benefit
16    association, a burial society, or a farm mutual, $200.
17        (m) For filing annual statement by a domestic
18    fraternal benefit society, $100.
19        (n) For filing annual statement by a farm mutual, a
20    mutual benefit association, or a burial society, $50.
21        (o) For issuing a certificate of authority or renewal
22    thereof except to a foreign fraternal benefit society,
23    $400.
24        (p) For issuing a certificate of authority or renewal
25    thereof to a foreign fraternal benefit society, $200.
26        (q) For issuing an amended certificate of authority,

 

 

HB5493 Enrolled- 55 -LRB103 39189 RPS 69335 b

1    $50.
2        (r) For each certified copy of certificate of
3    authority, $20.
4        (s) For each certificate of deposit, or valuation, or
5    compliance or surety certificate, $20.
6        (t) For copies of papers or records per page, $1.
7        (u) For each certification to copies of papers or
8    records, $10.
9        (v) For multiple copies of documents or certificates
10    listed in subparagraphs (r), (s), and (u) of paragraph (1)
11    of this Section, $10 for the first copy of a certificate of
12    any type and $5 for each additional copy of the same
13    certificate requested at the same time, unless, pursuant
14    to paragraph (2) of this Section, the Director finds these
15    additional fees excessive.
16        (w) For issuing a permit to sell shares or increase
17    paid-up capital:
18            (i) in connection with a public stock offering,
19        $300;
20            (ii) in any other case, $100.
21        (x) For issuing any other certificate required or
22    permissible under the law, $50.
23        (y) For filing a plan of exchange of the stock of a
24    domestic stock insurance company, a plan of
25    demutualization of a domestic mutual company, or a plan of
26    reorganization under Article XII, $2,000.

 

 

HB5493 Enrolled- 56 -LRB103 39189 RPS 69335 b

1        (z) For filing a statement of acquisition of a
2    domestic company as defined in Section 131.4 of this Code,
3    $2,000.
4        (aa) For filing an agreement to purchase the business
5    of an organization authorized under the Dental Service
6    Plan Act or the Voluntary Health Services Plans Act or of a
7    health maintenance organization or a limited health
8    service organization, $2,000.
9        (bb) For filing a statement of acquisition of a
10    foreign or alien insurance company as defined in Section
11    131.12a of this Code, $1,000.
12        (cc) For filing a registration statement as required
13    in Sections 131.13 and 131.14, the notification as
14    required by Sections 131.16, 131.20a, or 141.4, or an
15    agreement or transaction required by Sections 124.2(2),
16    141, 141a, or 141.1, $200.
17        (dd) For filing an application for licensing of:
18            (i) a religious or charitable risk pooling trust
19        or a workers' compensation pool, $1,000;
20            (ii) a workers' compensation service company,
21        $500;
22            (iii) a self-insured automobile fleet, $200; or
23            (iv) a renewal of or amendment of any license
24        issued pursuant to (i), (ii), or (iii) above, $100.
25        (ee) For filing articles of incorporation for a
26    syndicate to engage in the business of insurance through

 

 

HB5493 Enrolled- 57 -LRB103 39189 RPS 69335 b

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

 

 

HB5493 Enrolled- 58 -LRB103 39189 RPS 69335 b

1        issued regardless of the number of forms comprising
2        that policy shall not exceed $1,500. For advisory or
3        rating organizations, fees charged for a policy filed
4        as it will be issued regardless of the number of forms
5        comprising that policy shall not exceed $2,500.
6            (iv) The Director may by rule exempt forms from
7        such fees.
8        (kk) For filing an application for licensing of a
9    reinsurance intermediary, $500.
10        (ll) For filing an application for renewal of a
11    license of a reinsurance intermediary, $200.
12        (mm) For filing a plan of division of a domestic stock
13    company under Article IIB, $100,000 $10,000.
14        (nn) For filing all documents submitted by a foreign
15    or alien company to be a certified reinsurer in this
16    State, except for a fraternal benefit society, $1,000.
17        (oo) For filing a renewal by a foreign or alien
18    company to be a certified reinsurer in this State, except
19    for a fraternal benefit society, $400.
20        (pp) For filing all documents submitted by a reinsurer
21    domiciled in a reciprocal jurisdiction, $1,000.
22        (qq) For filing a renewal by a reinsurer domiciled in
23    a reciprocal jurisdiction, $400.
24        (rr) For registering a captive management company or
25    renewal thereof, $50.
26    (2) When printed copies or numerous copies of the same

 

 

HB5493 Enrolled- 59 -LRB103 39189 RPS 69335 b

1paper or records are furnished or certified, the Director may
2reduce such fees for copies if he finds them excessive. He may,
3when he considers it in the public interest, furnish without
4charge to state insurance departments and persons other than
5companies, copies or certified copies of reports of
6examinations and of other papers and records.
7    (3) The expenses incurred in any performance examination
8authorized by law shall be paid by the company or person being
9examined. The charge shall be reasonably related to the cost
10of the examination including but not limited to compensation
11of examiners, electronic data processing costs, supervision
12and preparation of an examination report and lodging and
13travel expenses. All lodging and travel expenses shall be in
14accord with the applicable travel regulations as published by
15the Department of Central Management Services and approved by
16the Governor's Travel Control Board, except that out-of-state
17lodging and travel expenses related to examinations authorized
18under Section 132 shall be in accordance with travel rates
19prescribed under paragraph 301-7.2 of the Federal Travel
20Regulations, 41 CFR C.F.R. 301-7.2, for reimbursement of
21subsistence expenses incurred during official travel. All
22lodging and travel expenses may be reimbursed directly upon
23authorization of the Director. With the exception of the
24direct reimbursements authorized by the Director, all
25performance examination charges collected by the Department
26shall be paid to the Insurance Producer Administration Fund,

 

 

HB5493 Enrolled- 60 -LRB103 39189 RPS 69335 b

1however, the electronic data processing costs incurred by the
2Department in the performance of any examination shall be
3billed directly to the company being examined for payment to
4the Technology Management Revolving Fund.
5    (4) At the time of any service of process on the Director
6as attorney for such service, the Director shall charge and
7collect the sum of $40, which may be recovered as taxable costs
8by the party to the suit or action causing such service to be
9made if he prevails in such suit or action.
10    (5) (a) The costs incurred by the Department of Insurance
11in conducting any hearing authorized by law shall be assessed
12against the parties to the hearing in such proportion as the
13Director of Insurance may determine upon consideration of all
14relevant circumstances including: (1) the nature of the
15hearing; (2) whether the hearing was instigated by, or for the
16benefit of a particular party or parties; (3) whether there is
17a successful party on the merits of the proceeding; and (4) the
18relative levels of participation by the parties.
19    (b) For purposes of this subsection (5) costs incurred
20shall mean the hearing officer fees, court reporter fees, and
21travel expenses of Department of Insurance officers and
22employees; provided however, that costs incurred shall not
23include hearing officer fees or court reporter fees unless the
24Department has retained the services of independent
25contractors or outside experts to perform such functions.
26    (c) The Director shall make the assessment of costs

 

 

HB5493 Enrolled- 61 -LRB103 39189 RPS 69335 b

1incurred as part of the final order or decision arising out of
2the proceeding; provided, however, that such order or decision
3shall include findings and conclusions in support of the
4assessment of costs. This subsection (5) shall not be
5construed as permitting the payment of travel expenses unless
6calculated in accordance with the applicable travel
7regulations of the Department of Central Management Services,
8as approved by the Governor's Travel Control Board. The
9Director as part of such order or decision shall require all
10assessments for hearing officer fees and court reporter fees,
11if any, to be paid directly to the hearing officer or court
12reporter by the party(s) assessed for such costs. The
13assessments for travel expenses of Department officers and
14employees shall be reimbursable to the Director of Insurance
15for deposit to the fund out of which those expenses had been
16paid.
17    (d) The provisions of this subsection (5) shall apply in
18the case of any hearing conducted by the Director of Insurance
19not otherwise specifically provided for by law.
20    (6) The Director shall charge and collect an annual
21financial regulation fee from every domestic company for
22examination and analysis of its financial condition and to
23fund the internal costs and expenses of the Interstate
24Insurance Receivership Commission as may be allocated to the
25State of Illinois and companies doing an insurance business in
26this State pursuant to Article X of the Interstate Insurance

 

 

HB5493 Enrolled- 62 -LRB103 39189 RPS 69335 b

1Receivership Compact. The fee shall be the greater fixed
2amount based upon the combination of nationwide direct premium
3income and nationwide reinsurance assumed premium income or
4upon admitted assets calculated under this subsection as
5follows:
6        (a) Combination of nationwide direct premium income
7    and nationwide reinsurance assumed premium.
8            (i) $150, if the premium is less than $500,000 and
9        there is no reinsurance assumed premium;
10            (ii) $750, if the premium is $500,000 or more, but
11        less than $5,000,000 and there is no reinsurance
12        assumed premium; or if the premium is less than
13        $5,000,000 and the reinsurance assumed premium is less
14        than $10,000,000;
15            (iii) $3,750, if the premium is less than
16        $5,000,000 and the reinsurance assumed premium is
17        $10,000,000 or more;
18            (iv) $7,500, if the premium is $5,000,000 or more,
19        but less than $10,000,000;
20            (v) $18,000, if the premium is $10,000,000 or
21        more, but less than $25,000,000;
22            (vi) $22,500, if the premium is $25,000,000 or
23        more, but less than $50,000,000;
24            (vii) $30,000, if the premium is $50,000,000 or
25        more, but less than $100,000,000;
26            (viii) $37,500, if the premium is $100,000,000 or

 

 

HB5493 Enrolled- 63 -LRB103 39189 RPS 69335 b

1        more.
2        (b) Admitted assets.
3            (i) $150, if admitted assets are less than
4        $1,000,000;
5            (ii) $750, if admitted assets are $1,000,000 or
6        more, but less than $5,000,000;
7            (iii) $3,750, if admitted assets are $5,000,000 or
8        more, but less than $25,000,000;
9            (iv) $7,500, if admitted assets are $25,000,000 or
10        more, but less than $50,000,000;
11            (v) $18,000, if admitted assets are $50,000,000 or
12        more, but less than $100,000,000;
13            (vi) $22,500, if admitted assets are $100,000,000
14        or more, but less than $500,000,000;
15            (vii) $30,000, if admitted assets are $500,000,000
16        or more, but less than $1,000,000,000;
17            (viii) $37,500, if admitted assets are
18        $1,000,000,000 or more.
19        (c) The sum of financial regulation fees charged to
20    the domestic companies of the same affiliated group shall
21    not exceed $250,000 in the aggregate in any single year
22    and shall be billed by the Director to the member company
23    designated by the group.
24    (7) The Director shall charge and collect an annual
25financial regulation fee from every foreign or alien company,
26except fraternal benefit societies, for the examination and

 

 

HB5493 Enrolled- 64 -LRB103 39189 RPS 69335 b

1analysis of its financial condition and to fund the internal
2costs and expenses of the Interstate Insurance Receivership
3Commission as may be allocated to the State of Illinois and
4companies doing an insurance business in this State pursuant
5to Article X of the Interstate Insurance Receivership Compact.
6The fee shall be a fixed amount based upon Illinois direct
7premium income and nationwide reinsurance assumed premium
8income in accordance with the following schedule:
9        (a) $150, if the premium is less than $500,000 and
10    there is no reinsurance assumed premium;
11        (b) $750, if the premium is $500,000 or more, but less
12    than $5,000,000 and there is no reinsurance assumed
13    premium; or if the premium is less than $5,000,000 and the
14    reinsurance assumed premium is less than $10,000,000;
15        (c) $3,750, if the premium is less than $5,000,000 and
16    the reinsurance assumed premium is $10,000,000 or more;
17        (d) $7,500, if the premium is $5,000,000 or more, but
18    less than $10,000,000;
19        (e) $18,000, if the premium is $10,000,000 or more,
20    but less than $25,000,000;
21        (f) $22,500, if the premium is $25,000,000 or more,
22    but less than $50,000,000;
23        (g) $30,000, if the premium is $50,000,000 or more,
24    but less than $100,000,000;
25        (h) $37,500, if the premium is $100,000,000 or more.
26    The sum of financial regulation fees under this subsection

 

 

HB5493 Enrolled- 65 -LRB103 39189 RPS 69335 b

1(7) charged to the foreign or alien companies within the same
2affiliated group shall not exceed $250,000 in the aggregate in
3any single year and shall be billed by the Director to the
4member company designated by the group.
5    (8) Beginning January 1, 1992, the financial regulation
6fees imposed under subsections (6) and (7) of this Section
7shall be paid by each company or domestic affiliated group
8annually. After January 1, 1994, the fee shall be billed by
9Department invoice based upon the company's premium income or
10admitted assets as shown in its annual statement for the
11preceding calendar year. The invoice is due upon receipt and
12must be paid no later than June 30 of each calendar year. All
13financial regulation fees collected by the Department shall be
14paid to the Insurance Financial Regulation Fund. The
15Department may not collect financial examiner per diem charges
16from companies subject to subsections (6) and (7) of this
17Section undergoing financial examination after June 30, 1992.
18    (9) In addition to the financial regulation fee required
19by this Section, a company undergoing any financial
20examination authorized by law shall pay the following costs
21and expenses incurred by the Department: electronic data
22processing costs, the expenses authorized under Section 131.21
23and subsection (d) of Section 132.4 of this Code, and lodging
24and travel expenses.
25    Electronic data processing costs incurred by the
26Department in the performance of any examination shall be

 

 

HB5493 Enrolled- 66 -LRB103 39189 RPS 69335 b

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

 

 

HB5493 Enrolled- 67 -LRB103 39189 RPS 69335 b

1payment of $150 or more as required under this Section shall be
2subject to the penalty and interest provisions provided for in
3subsections (4) and (7) of Section 412.
4    (11) Unless otherwise specified, all of the fees collected
5under this Section shall be paid into the Insurance Financial
6Regulation Fund.
7    (12) For purposes of this Section:
8        (a) "Domestic company" means a company as defined in
9    Section 2 of this Code which is incorporated or organized
10    under the laws of this State, and in addition includes a
11    not-for-profit corporation authorized under the Dental
12    Service Plan Act or the Voluntary Health Services Plans
13    Act, a health maintenance organization, and a limited
14    health service organization.
15        (b) "Foreign company" means a company as defined in
16    Section 2 of this Code which is incorporated or organized
17    under the laws of any state of the United States other than
18    this State and in addition includes a health maintenance
19    organization and a limited health service organization
20    which is incorporated or organized under the laws of any
21    state of the United States other than this State.
22        (c) "Alien company" means a company as defined in
23    Section 2 of this Code which is incorporated or organized
24    under the laws of any country other than the United
25    States.
26        (d) "Fraternal benefit society" means a corporation,

 

 

HB5493 Enrolled- 68 -LRB103 39189 RPS 69335 b

1    society, order, lodge or voluntary association as defined
2    in Section 282.1 of this Code.
3        (e) "Mutual benefit association" means a company,
4    association or corporation authorized by the Director to
5    do business in this State under the provisions of Article
6    XVIII of this Code.
7        (f) "Burial society" means a person, firm,
8    corporation, society or association of individuals
9    authorized by the Director to do business in this State
10    under the provisions of Article XIX of this Code.
11        (g) "Farm mutual" means a district, county and
12    township mutual insurance company authorized by the
13    Director to do business in this State under the provisions
14    of the Farm Mutual Insurance Company Act of 1986.
15(Source: P.A. 102-775, eff. 5-13-22.)
 
16    (Text of Section after amendment by P.A. 103-75)
17    Sec. 408. Fees and charges.
18    (1) The Director shall charge, collect and give proper
19acquittances for the payment of the following fees and
20charges:
21        (a) For filing all documents submitted for the
22    incorporation or organization or certification of a
23    domestic company, except for a fraternal benefit society,
24    $2,000.
25        (b) For filing all documents submitted for the

 

 

HB5493 Enrolled- 69 -LRB103 39189 RPS 69335 b

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

 

 

HB5493 Enrolled- 70 -LRB103 39189 RPS 69335 b

1    fraternal benefit society, $5,000.
2        (j) For filing all documents submitted by a foreign or
3    alien fraternal benefit society to be admitted to transact
4    business in this State, $500.
5        (k) For filing declaration of withdrawal of a foreign
6    or alien company, $50.
7        (l) For filing annual statement by a domestic company,
8    except a fraternal benefit society, a mutual benefit
9    association, a burial society, or a farm mutual, $200.
10        (m) For filing annual statement by a domestic
11    fraternal benefit society, $100.
12        (n) For filing annual statement by a farm mutual, a
13    mutual benefit association, or a burial society, $50.
14        (o) For issuing a certificate of authority or renewal
15    thereof except to a foreign fraternal benefit society,
16    $400.
17        (p) For issuing a certificate of authority or renewal
18    thereof to a foreign fraternal benefit society, $200.
19        (q) For issuing an amended certificate of authority,
20    $50.
21        (r) For each certified copy of certificate of
22    authority, $20.
23        (s) For each certificate of deposit, or valuation, or
24    compliance or surety certificate, $20.
25        (t) For copies of papers or records per page, $1.
26        (u) For each certification to copies of papers or

 

 

HB5493 Enrolled- 71 -LRB103 39189 RPS 69335 b

1    records, $10.
2        (v) For multiple copies of documents or certificates
3    listed in subparagraphs (r), (s), and (u) of paragraph (1)
4    of this Section, $10 for the first copy of a certificate of
5    any type and $5 for each additional copy of the same
6    certificate requested at the same time, unless, pursuant
7    to paragraph (2) of this Section, the Director finds these
8    additional fees excessive.
9        (w) For issuing a permit to sell shares or increase
10    paid-up capital:
11            (i) in connection with a public stock offering,
12        $300;
13            (ii) in any other case, $100.
14        (x) For issuing any other certificate required or
15    permissible under the law, $50.
16        (y) For filing a plan of exchange of the stock of a
17    domestic stock insurance company, a plan of
18    demutualization of a domestic mutual company, or a plan of
19    reorganization under Article XII, $2,000.
20        (z) For filing a statement of acquisition of a
21    domestic company as defined in Section 131.4 of this Code,
22    $2,000.
23        (aa) For filing an agreement to purchase the business
24    of an organization authorized under the Dental Service
25    Plan Act or the Voluntary Health Services Plans Act or of a
26    health maintenance organization or a limited health

 

 

HB5493 Enrolled- 72 -LRB103 39189 RPS 69335 b

1    service organization, $2,000.
2        (bb) For filing a statement of acquisition of a
3    foreign or alien insurance company as defined in Section
4    131.12a of this Code, $1,000.
5        (cc) For filing a registration statement as required
6    in Sections 131.13 and 131.14, the notification as
7    required by Sections 131.16, 131.20a, or 141.4, or an
8    agreement or transaction required by Sections 124.2(2),
9    141, 141a, or 141.1, $200.
10        (dd) For filing an application for licensing of:
11            (i) a religious or charitable risk pooling trust
12        or a workers' compensation pool, $1,000;
13            (ii) a workers' compensation service company,
14        $500;
15            (iii) a self-insured automobile fleet, $200; or
16            (iv) a renewal of or amendment of any license
17        issued pursuant to (i), (ii), or (iii) above, $100.
18        (ee) For filing articles of incorporation for a
19    syndicate to engage in the business of insurance through
20    the Illinois Insurance Exchange, $2,000.
21        (ff) For filing amended articles of incorporation for
22    a syndicate engaged in the business of insurance through
23    the Illinois Insurance Exchange, $100.
24        (gg) For filing articles of incorporation for a
25    limited syndicate to join with other subscribers or
26    limited syndicates to do business through the Illinois

 

 

HB5493 Enrolled- 73 -LRB103 39189 RPS 69335 b

1    Insurance Exchange, $1,000.
2        (hh) For filing amended articles of incorporation for
3    a limited syndicate to do business through the Illinois
4    Insurance Exchange, $100.
5        (ii) For a permit to solicit subscriptions to a
6    syndicate or limited syndicate, $100.
7        (jj) For the filing of each form as required in
8    Section 143 of this Code, $50 per form. Informational and
9    advertising filings shall be $25 per filing. The fee for
10    advisory and rating organizations shall be $200 per form.
11            (i) For the purposes of the form filing fee,
12        filings made on insert page basis will be considered
13        one form at the time of its original submission.
14        Changes made to a form subsequent to its approval
15        shall be considered a new filing.
16            (ii) Only one fee shall be charged for a form,
17        regardless of the number of other forms or policies
18        with which it will be used.
19            (iii) Fees charged for a policy filed as it will be
20        issued regardless of the number of forms comprising
21        that policy shall not exceed $1,500. For advisory or
22        rating organizations, fees charged for a policy filed
23        as it will be issued regardless of the number of forms
24        comprising that policy shall not exceed $2,500.
25            (iv) The Director may by rule exempt forms from
26        such fees.

 

 

HB5493 Enrolled- 74 -LRB103 39189 RPS 69335 b

1        (kk) For filing an application for licensing of a
2    reinsurance intermediary, $500.
3        (ll) For filing an application for renewal of a
4    license of a reinsurance intermediary, $200.
5        (mm) For filing a plan of division of a domestic stock
6    company under Article IIB, $100,000 $10,000.
7        (nn) For filing all documents submitted by a foreign
8    or alien company to be a certified reinsurer in this
9    State, except for a fraternal benefit society, $1,000.
10        (oo) For filing a renewal by a foreign or alien
11    company to be a certified reinsurer in this State, except
12    for a fraternal benefit society, $400.
13        (pp) For filing all documents submitted by a reinsurer
14    domiciled in a reciprocal jurisdiction, $1,000.
15        (qq) For filing a renewal by a reinsurer domiciled in
16    a reciprocal jurisdiction, $400.
17        (rr) For registering a captive management company or
18    renewal thereof, $50.
19        (ss) For filing an insurance business transfer plan
20    under Article XLVII, $100,000 $25,000.
21    (2) When printed copies or numerous copies of the same
22paper or records are furnished or certified, the Director may
23reduce such fees for copies if he finds them excessive. He may,
24when he considers it in the public interest, furnish without
25charge to state insurance departments and persons other than
26companies, copies or certified copies of reports of

 

 

HB5493 Enrolled- 75 -LRB103 39189 RPS 69335 b

1examinations and of other papers and records.
2    (3) The expenses incurred in any performance examination
3authorized by law shall be paid by the company or person being
4examined. The charge shall be reasonably related to the cost
5of the examination including but not limited to compensation
6of examiners, electronic data processing costs, supervision
7and preparation of an examination report and lodging and
8travel expenses. All lodging and travel expenses shall be in
9accord with the applicable travel regulations as published by
10the Department of Central Management Services and approved by
11the Governor's Travel Control Board, except that out-of-state
12lodging and travel expenses related to examinations authorized
13under Section 132 shall be in accordance with travel rates
14prescribed under paragraph 301-7.2 of the Federal Travel
15Regulations, 41 CFR C.F.R. 301-7.2, for reimbursement of
16subsistence expenses incurred during official travel. All
17lodging and travel expenses may be reimbursed directly upon
18authorization of the Director. With the exception of the
19direct reimbursements authorized by the Director, all
20performance examination charges collected by the Department
21shall be paid to the Insurance Producer Administration Fund,
22however, the electronic data processing costs incurred by the
23Department in the performance of any examination shall be
24billed directly to the company being examined for payment to
25the Technology Management Revolving Fund.
26    (4) At the time of any service of process on the Director

 

 

HB5493 Enrolled- 76 -LRB103 39189 RPS 69335 b

1as attorney for such service, the Director shall charge and
2collect the sum of $40, which may be recovered as taxable costs
3by the party to the suit or action causing such service to be
4made if he prevails in such suit or action.
5    (5) (a) The costs incurred by the Department of Insurance
6in conducting any hearing authorized by law shall be assessed
7against the parties to the hearing in such proportion as the
8Director of Insurance may determine upon consideration of all
9relevant circumstances including: (1) the nature of the
10hearing; (2) whether the hearing was instigated by, or for the
11benefit of a particular party or parties; (3) whether there is
12a successful party on the merits of the proceeding; and (4) the
13relative levels of participation by the parties.
14    (b) For purposes of this subsection (5) costs incurred
15shall mean the hearing officer fees, court reporter fees, and
16travel expenses of Department of Insurance officers and
17employees; provided however, that costs incurred shall not
18include hearing officer fees or court reporter fees unless the
19Department has retained the services of independent
20contractors or outside experts to perform such functions.
21    (c) The Director shall make the assessment of costs
22incurred as part of the final order or decision arising out of
23the proceeding; provided, however, that such order or decision
24shall include findings and conclusions in support of the
25assessment of costs. This subsection (5) shall not be
26construed as permitting the payment of travel expenses unless

 

 

HB5493 Enrolled- 77 -LRB103 39189 RPS 69335 b

1calculated in accordance with the applicable travel
2regulations of the Department of Central Management Services,
3as approved by the Governor's Travel Control Board. The
4Director as part of such order or decision shall require all
5assessments for hearing officer fees and court reporter fees,
6if any, to be paid directly to the hearing officer or court
7reporter by the party(s) assessed for such costs. The
8assessments for travel expenses of Department officers and
9employees shall be reimbursable to the Director of Insurance
10for deposit to the fund out of which those expenses had been
11paid.
12    (d) The provisions of this subsection (5) shall apply in
13the case of any hearing conducted by the Director of Insurance
14not otherwise specifically provided for by law.
15    (6) The Director shall charge and collect an annual
16financial regulation fee from every domestic company for
17examination and analysis of its financial condition and to
18fund the internal costs and expenses of the Interstate
19Insurance Receivership Commission as may be allocated to the
20State of Illinois and companies doing an insurance business in
21this State pursuant to Article X of the Interstate Insurance
22Receivership Compact. The fee shall be the greater fixed
23amount based upon the combination of nationwide direct premium
24income and nationwide reinsurance assumed premium income or
25upon admitted assets calculated under this subsection as
26follows:

 

 

HB5493 Enrolled- 78 -LRB103 39189 RPS 69335 b

1        (a) Combination of nationwide direct premium income
2    and nationwide reinsurance assumed premium.
3            (i) $150, if the premium is less than $500,000 and
4        there is no reinsurance assumed premium;
5            (ii) $750, if the premium is $500,000 or more, but
6        less than $5,000,000 and there is no reinsurance
7        assumed premium; or if the premium is less than
8        $5,000,000 and the reinsurance assumed premium is less
9        than $10,000,000;
10            (iii) $3,750, if the premium is less than
11        $5,000,000 and the reinsurance assumed premium is
12        $10,000,000 or more;
13            (iv) $7,500, if the premium is $5,000,000 or more,
14        but less than $10,000,000;
15            (v) $18,000, if the premium is $10,000,000 or
16        more, but less than $25,000,000;
17            (vi) $22,500, if the premium is $25,000,000 or
18        more, but less than $50,000,000;
19            (vii) $30,000, if the premium is $50,000,000 or
20        more, but less than $100,000,000;
21            (viii) $37,500, if the premium is $100,000,000 or
22        more.
23        (b) Admitted assets.
24            (i) $150, if admitted assets are less than
25        $1,000,000;
26            (ii) $750, if admitted assets are $1,000,000 or

 

 

HB5493 Enrolled- 79 -LRB103 39189 RPS 69335 b

1        more, but less than $5,000,000;
2            (iii) $3,750, if admitted assets are $5,000,000 or
3        more, but less than $25,000,000;
4            (iv) $7,500, if admitted assets are $25,000,000 or
5        more, but less than $50,000,000;
6            (v) $18,000, if admitted assets are $50,000,000 or
7        more, but less than $100,000,000;
8            (vi) $22,500, if admitted assets are $100,000,000
9        or more, but less than $500,000,000;
10            (vii) $30,000, if admitted assets are $500,000,000
11        or more, but less than $1,000,000,000;
12            (viii) $37,500, if admitted assets are
13        $1,000,000,000 or more.
14        (c) The sum of financial regulation fees charged to
15    the domestic companies of the same affiliated group shall
16    not exceed $250,000 in the aggregate in any single year
17    and shall be billed by the Director to the member company
18    designated by the group.
19    (7) The Director shall charge and collect an annual
20financial regulation fee from every foreign or alien company,
21except fraternal benefit societies, for the examination and
22analysis of its financial condition and to fund the internal
23costs and expenses of the Interstate Insurance Receivership
24Commission as may be allocated to the State of Illinois and
25companies doing an insurance business in this State pursuant
26to Article X of the Interstate Insurance Receivership Compact.

 

 

HB5493 Enrolled- 80 -LRB103 39189 RPS 69335 b

1The fee shall be a fixed amount based upon Illinois direct
2premium income and nationwide reinsurance assumed premium
3income in accordance with the following schedule:
4        (a) $150, if the premium is less than $500,000 and
5    there is no reinsurance assumed premium;
6        (b) $750, if the premium is $500,000 or more, but less
7    than $5,000,000 and there is no reinsurance assumed
8    premium; or if the premium is less than $5,000,000 and the
9    reinsurance assumed premium is less than $10,000,000;
10        (c) $3,750, if the premium is less than $5,000,000 and
11    the reinsurance assumed premium is $10,000,000 or more;
12        (d) $7,500, if the premium is $5,000,000 or more, but
13    less than $10,000,000;
14        (e) $18,000, if the premium is $10,000,000 or more,
15    but less than $25,000,000;
16        (f) $22,500, if the premium is $25,000,000 or more,
17    but less than $50,000,000;
18        (g) $30,000, if the premium is $50,000,000 or more,
19    but less than $100,000,000;
20        (h) $37,500, if the premium is $100,000,000 or more.
21    The sum of financial regulation fees under this subsection
22(7) charged to the foreign or alien companies within the same
23affiliated group shall not exceed $250,000 in the aggregate in
24any single year and shall be billed by the Director to the
25member company designated by the group.
26    (8) Beginning January 1, 1992, the financial regulation

 

 

HB5493 Enrolled- 81 -LRB103 39189 RPS 69335 b

1fees imposed under subsections (6) and (7) of this Section
2shall be paid by each company or domestic affiliated group
3annually. After January 1, 1994, the fee shall be billed by
4Department invoice based upon the company's premium income or
5admitted assets as shown in its annual statement for the
6preceding calendar year. The invoice is due upon receipt and
7must be paid no later than June 30 of each calendar year. All
8financial regulation fees collected by the Department shall be
9paid to the Insurance Financial Regulation Fund. The
10Department may not collect financial examiner per diem charges
11from companies subject to subsections (6) and (7) of this
12Section undergoing financial examination after June 30, 1992.
13    (9) In addition to the financial regulation fee required
14by this Section, a company undergoing any financial
15examination authorized by law shall pay the following costs
16and expenses incurred by the Department: electronic data
17processing costs, the expenses authorized under Section 131.21
18and subsection (d) of Section 132.4 of this Code, and lodging
19and travel expenses.
20    Electronic data processing costs incurred by the
21Department in the performance of any examination shall be
22billed directly to the company undergoing examination for
23payment to the Technology Management Revolving Fund. Except
24for direct reimbursements authorized by the Director or direct
25payments made under Section 131.21 or subsection (d) of
26Section 132.4 of this Code, all financial regulation fees and

 

 

HB5493 Enrolled- 82 -LRB103 39189 RPS 69335 b

1all financial examination charges collected by the Department
2shall be paid to the Insurance Financial Regulation Fund.
3    All lodging and travel expenses shall be in accordance
4with applicable travel regulations published by the Department
5of Central Management Services and approved by the Governor's
6Travel Control Board, except that out-of-state lodging and
7travel expenses related to examinations authorized under
8Sections 132.1 through 132.7 shall be in accordance with
9travel rates prescribed under paragraph 301-7.2 of the Federal
10Travel Regulations, 41 CFR C.F.R. 301-7.2, for reimbursement
11of subsistence expenses incurred during official travel. All
12lodging and travel expenses may be reimbursed directly upon
13the authorization of the Director.
14    In the case of an organization or person not subject to the
15financial regulation fee, the expenses incurred in any
16financial examination authorized by law shall be paid by the
17organization or person being examined. The charge shall be
18reasonably related to the cost of the examination including,
19but not limited to, compensation of examiners and other costs
20described in this subsection.
21    (10) Any company, person, or entity failing to make any
22payment of $150 or more as required under this Section shall be
23subject to the penalty and interest provisions provided for in
24subsections (4) and (7) of Section 412.
25    (11) Unless otherwise specified, all of the fees collected
26under this Section shall be paid into the Insurance Financial

 

 

HB5493 Enrolled- 83 -LRB103 39189 RPS 69335 b

1Regulation Fund.
2    (12) For purposes of this Section:
3        (a) "Domestic company" means a company as defined in
4    Section 2 of this Code which is incorporated or organized
5    under the laws of this State, and in addition includes a
6    not-for-profit corporation authorized under the Dental
7    Service Plan Act or the Voluntary Health Services Plans
8    Act, a health maintenance organization, and a limited
9    health service organization.
10        (b) "Foreign company" means a company as defined in
11    Section 2 of this Code which is incorporated or organized
12    under the laws of any state of the United States other than
13    this State and in addition includes a health maintenance
14    organization and a limited health service organization
15    which is incorporated or organized under the laws of any
16    state of the United States other than this State.
17        (c) "Alien company" means a company as defined in
18    Section 2 of this Code which is incorporated or organized
19    under the laws of any country other than the United
20    States.
21        (d) "Fraternal benefit society" means a corporation,
22    society, order, lodge or voluntary association as defined
23    in Section 282.1 of this Code.
24        (e) "Mutual benefit association" means a company,
25    association or corporation authorized by the Director to
26    do business in this State under the provisions of Article

 

 

HB5493 Enrolled- 84 -LRB103 39189 RPS 69335 b

1    XVIII of this Code.
2        (f) "Burial society" means a person, firm,
3    corporation, society or association of individuals
4    authorized by the Director to do business in this State
5    under the provisions of Article XIX of this Code.
6        (g) "Farm mutual" means a district, county and
7    township mutual insurance company authorized by the
8    Director to do business in this State under the provisions
9    of the Farm Mutual Insurance Company Act of 1986.
10(Source: P.A. 102-775, eff. 5-13-22; 103-75, eff. 1-1-25.)
 
11    (215 ILCS 5/412)  (from Ch. 73, par. 1024)
12    Sec. 412. Refunds; penalties; collection.
13    (1)(a) Whenever it appears to the satisfaction of the
14Director that because of some mistake of fact, error in
15calculation, or erroneous interpretation of a statute of this
16or any other state, any authorized company, surplus line
17producer, or industrial insured has paid to him, pursuant to
18any provision of law, taxes, fees, or other charges in excess
19of the amount legally chargeable against it, during the 6-year
206 year period immediately preceding the discovery of such
21overpayment, he shall have power to refund to such company,
22surplus line producer, or industrial insured the amount of the
23excess or excesses by applying the amount or amounts thereof
24toward the payment of taxes, fees, or other charges already
25due, or which may thereafter become due from that company

 

 

HB5493 Enrolled- 85 -LRB103 39189 RPS 69335 b

1until such excess or excesses have been fully refunded, or
2upon a written request from the authorized company, surplus
3line producer, or industrial insured, the Director shall
4provide a cash refund within 120 days after receipt of the
5written request if all necessary information has been filed
6with the Department in order for it to perform an audit of the
7tax report for the transaction or period or annual return for
8the year in which the overpayment occurred or within 120 days
9after the date the Department receives all the necessary
10information to perform such audit. The Director shall not
11provide a cash refund if there are insufficient funds in the
12Insurance Premium Tax Refund Fund to provide a cash refund, if
13the amount of the overpayment is less than $100, or if the
14amount of the overpayment can be fully offset against the
15taxpayer's estimated liability for the year following the year
16of the cash refund request. Any cash refund shall be paid from
17the Insurance Premium Tax Refund Fund, a special fund hereby
18created in the State treasury.
19    (b) As determined by the Director pursuant to paragraph
20(a) of this subsection, the Department shall deposit an amount
21of cash refunds approved by the Director for payment as a
22result of overpayment of tax liability collected under
23Sections 121-2.08, 409, 444, 444.1, and 445 of this Code into
24the Insurance Premium Tax Refund Fund.
25    (c) Beginning July 1, 1999, moneys in the Insurance
26Premium Tax Refund Fund shall be expended exclusively for the

 

 

HB5493 Enrolled- 86 -LRB103 39189 RPS 69335 b

1purpose of paying cash refunds resulting from overpayment of
2tax liability under Sections 121-2.08, 409, 444, 444.1, and
3445 of this Code as determined by the Director pursuant to
4subsection 1(a) of this Section. Cash refunds made in
5accordance with this Section may be made from the Insurance
6Premium Tax Refund Fund only to the extent that amounts have
7been deposited and retained in the Insurance Premium Tax
8Refund Fund.
9    (d) This Section shall constitute an irrevocable and
10continuing appropriation from the Insurance Premium Tax Refund
11Fund for the purpose of paying cash refunds pursuant to the
12provisions of this Section.
13    (2)(a) When any insurance company fails to file any tax
14return required under Sections 408.1, 409, 444, and 444.1 of
15this Code or Section 12 of the Fire Investigation Act on the
16date prescribed, including any extensions, there shall be
17added as a penalty $400 or 10% of the amount of such tax,
18whichever is greater, for each month or part of a month of
19failure to file, the entire penalty not to exceed $2,000 or 50%
20of the tax due, whichever is greater. In this paragraph, "tax
21due" means the full amount due for the applicable tax period
22under Section 408.1, 409, 444, or 444.1 of this Code or Section
2312 of the Fire Investigation Act.
24    (b) When any industrial insured or surplus line producer
25fails to file any tax return or report required under Sections
26121-2.08 and 445 of this Code or Section 12 of the Fire

 

 

HB5493 Enrolled- 87 -LRB103 39189 RPS 69335 b

1Investigation Act on the date prescribed, including any
2extensions, there shall be added:
3        (i) as a late fee, if the return or report is received
4    at least one day but not more than 15 days after the
5    prescribed due date, $50 or 5% of the tax due, whichever is
6    greater, the entire fee not to exceed $1,000;
7        (ii) as a late fee, if the return or report is received
8    at least 16 days but not more than 30 days after the
9    prescribed due date, $100 or 5% of the tax due, whichever
10    is greater, the entire fee not to exceed $2,000; or
11        (iii) as a penalty, if the return or report is
12    received more than 30 days after the prescribed due date,
13    $100 or 5% of the tax due, whichever is greater, for each
14    month or part of a month of failure to file, the entire
15    penalty not to exceed $500 or 30% of the tax due, whichever
16    is greater.
17    In this paragraph, "tax due" means the full amount due for
18the applicable tax period under Section 121-2.08 or 445 of
19this Code or Section 12 of the Fire Investigation Act. A tax
20return or report shall be deemed received as of the date mailed
21as evidenced by a postmark, proof of mailing on a recognized
22United States Postal Service form or a form acceptable to the
23United States Postal Service or other commercial mail delivery
24service, or other evidence acceptable to the Director.
25    (3)(a) When any insurance company fails to pay the full
26amount due under the provisions of this Section, Sections

 

 

HB5493 Enrolled- 88 -LRB103 39189 RPS 69335 b

1408.1, 409, 444, or 444.1 of this Code, or Section 12 of the
2Fire Investigation Act, there shall be added to the amount due
3as a penalty an amount equal to 10% of the deficiency.
4    (a-5) When any industrial insured or surplus line producer
5fails to pay the full amount due under the provisions of this
6Section, Sections 121-2.08 or 445 of this Code, or Section 12
7of the Fire Investigation Act on the date prescribed, there
8shall be added:
9        (i) as a late fee, if the payment is received at least
10    one day but not more than 7 days after the prescribed due
11    date, 10% of the tax due, the entire fee not to exceed
12    $1,000;
13        (ii) as a late fee, if the payment is received at least
14    8 days but not more than 14 days after the prescribed due
15    date, 10% of the tax due, the entire fee not to exceed
16    $1,500;
17        (iii) as a late fee, if the payment is received at
18    least 15 days but not more than 21 days after the
19    prescribed due date, 10% of the tax due, the entire fee not
20    to exceed $2,000; or
21        (iv) as a penalty, if the return or report is received
22    more than 21 days after the prescribed due date, 10% of the
23    tax due.
24    In this paragraph, "tax due" means the full amount due for
25the applicable tax period under this Section, Section 121-2.08
26or 445 of this Code, or Section 12 of the Fire Investigation

 

 

HB5493 Enrolled- 89 -LRB103 39189 RPS 69335 b

1Act. A tax payment shall be deemed received as of the date
2mailed as evidenced by a postmark, proof of mailing on a
3recognized United States Postal Service form or a form
4acceptable to the United States Postal Service or other
5commercial mail delivery service, or other evidence acceptable
6to the Director.
7    (b) If such failure to pay is determined by the Director to
8be willful wilful, after a hearing under Sections 402 and 403,
9there shall be added to the tax as a penalty an amount equal to
10the greater of 50% of the deficiency or 10% of the amount due
11and unpaid for each month or part of a month that the
12deficiency remains unpaid commencing with the date that the
13amount becomes due. Such amount shall be in lieu of any
14determined under paragraph (a) or (a-5).
15    (4) Any insurance company, industrial insured, or surplus
16line producer that fails to pay the full amount due under this
17Section or Sections 121-2.08, 408.1, 409, 444, 444.1, or 445
18of this Code, or Section 12 of the Fire Investigation Act is
19liable, in addition to the tax and any late fees and penalties,
20for interest on such deficiency at the rate of 12% per annum,
21or at such higher adjusted rates as are or may be established
22under subsection (b) of Section 6621 of the Internal Revenue
23Code, from the date that payment of any such tax was due,
24determined without regard to any extensions, to the date of
25payment of such amount.
26    (5) The Director, through the Attorney General, may

 

 

HB5493 Enrolled- 90 -LRB103 39189 RPS 69335 b

1institute an action in the name of the People of the State of
2Illinois, in any court of competent jurisdiction, for the
3recovery of the amount of such taxes, fees, and penalties due,
4and prosecute the same to final judgment, and take such steps
5as are necessary to collect the same.
6    (6) In the event that the certificate of authority of a
7foreign or alien company is revoked for any cause or the
8company withdraws from this State prior to the renewal date of
9the certificate of authority as provided in Section 114, the
10company may recover the amount of any such tax paid in advance.
11Except as provided in this subsection, no revocation or
12withdrawal excuses payment of or constitutes grounds for the
13recovery of any taxes or penalties imposed by this Code.
14    (7) When an insurance company or domestic affiliated group
15fails to pay the full amount of any fee of $200 or more due
16under Section 408 of this Code, there shall be added to the
17amount due as a penalty the greater of $100 or an amount equal
18to 10% of the deficiency for each month or part of a month that
19the deficiency remains unpaid.
20    (8) The Department shall have a lien for the taxes, fees,
21charges, fines, penalties, interest, other charges, or any
22portion thereof, imposed or assessed pursuant to this Code,
23upon all the real and personal property of any company or
24person to whom the assessment or final order has been issued or
25whenever a tax return is filed without payment of the tax or
26penalty shown therein to be due, including all such property

 

 

HB5493 Enrolled- 91 -LRB103 39189 RPS 69335 b

1of the company or person acquired after receipt of the
2assessment, issuance of the order, or filing of the return.
3The company or person is liable for the filing fee incurred by
4the Department for filing the lien and the filing fee incurred
5by the Department to file the release of that lien. The filing
6fees shall be paid to the Department in addition to payment of
7the tax, fee, charge, fine, penalty, interest, other charges,
8or any portion thereof, included in the amount of the lien.
9However, where the lien arises because of the issuance of a
10final order of the Director or tax assessment by the
11Department, the lien shall not attach and the notice referred
12to in this Section shall not be filed until all administrative
13proceedings or proceedings in court for review of the final
14order or assessment have terminated or the time for the taking
15thereof has expired without such proceedings being instituted.
16    Upon the granting of Department review after a lien has
17attached, the lien shall remain in full force except to the
18extent to which the final assessment may be reduced by a
19revised final assessment following the rehearing or review.
20The lien created by the issuance of a final assessment shall
21terminate, unless a notice of lien is filed, within 3 years
22after the date all proceedings in court for the review of the
23final assessment have terminated or the time for the taking
24thereof has expired without such proceedings being instituted,
25or (in the case of a revised final assessment issued pursuant
26to a rehearing or review by the Department) within 3 years

 

 

HB5493 Enrolled- 92 -LRB103 39189 RPS 69335 b

1after the date all proceedings in court for the review of such
2revised final assessment have terminated or the time for the
3taking thereof has expired without such proceedings being
4instituted. Where the lien results from the filing of a tax
5return without payment of the tax or penalty shown therein to
6be due, the lien shall terminate, unless a notice of lien is
7filed, within 3 years after the date when the return is filed
8with the Department.
9    The time limitation period on the Department's right to
10file a notice of lien shall not run during any period of time
11in which the order of any court has the effect of enjoining or
12restraining the Department from filing such notice of lien. If
13the Department finds that a company or person is about to
14depart from the State, to conceal himself or his property, or
15to do any other act tending to prejudice or to render wholly or
16partly ineffectual proceedings to collect the amount due and
17owing to the Department unless such proceedings are brought
18without delay, or if the Department finds that the collection
19of the amount due from any company or person will be
20jeopardized by delay, the Department shall give the company or
21person notice of such findings and shall make demand for
22immediate return and payment of the amount, whereupon the
23amount shall become immediately due and payable. If the
24company or person, within 5 days after the notice (or within
25such extension of time as the Department may grant), does not
26comply with the notice or show to the Department that the

 

 

HB5493 Enrolled- 93 -LRB103 39189 RPS 69335 b

1findings in the notice are erroneous, the Department may file
2a notice of jeopardy assessment lien in the office of the
3recorder of the county in which any property of the company or
4person may be located and shall notify the company or person of
5the filing. The jeopardy assessment lien shall have the same
6scope and effect as the statutory lien provided for in this
7Section. If the company or person believes that the company or
8person does not owe some or all of the tax for which the
9jeopardy assessment lien against the company or person has
10been filed, or that no jeopardy to the revenue in fact exists,
11the company or person may protest within 20 days after being
12notified by the Department of the filing of the jeopardy
13assessment lien and request a hearing, whereupon the
14Department shall hold a hearing in conformity with the
15provisions of this Code and, pursuant thereto, shall notify
16the company or person of its findings as to whether or not the
17jeopardy assessment lien will be released. If not, and if the
18company or person is aggrieved by this decision, the company
19or person may file an action for judicial review of the final
20determination of the Department in accordance with the
21Administrative Review Law. If, pursuant to such hearing (or
22after an independent determination of the facts by the
23Department without a hearing), the Department determines that
24some or all of the amount due covered by the jeopardy
25assessment lien is not owed by the company or person, or that
26no jeopardy to the revenue exists, or if on judicial review the

 

 

HB5493 Enrolled- 94 -LRB103 39189 RPS 69335 b

1final judgment of the court is that the company or person does
2not owe some or all of the amount due covered by the jeopardy
3assessment lien against them, or that no jeopardy to the
4revenue exists, the Department shall release its jeopardy
5assessment lien to the extent of such finding of nonliability
6for the amount, or to the extent of such finding of no jeopardy
7to the revenue. The Department shall also release its jeopardy
8assessment lien against the company or person whenever the
9amount due and owing covered by the lien, plus any interest
10which may be due, are paid and the company or person has paid
11the Department in cash or by guaranteed remittance an amount
12representing the filing fee for the lien and the filing fee for
13the release of that lien. The Department shall file that
14release of lien with the recorder of the county where that lien
15was filed.
16    Nothing in this Section shall be construed to give the
17Department a preference over the rights of any bona fide
18purchaser, holder of a security interest, mechanics
19lienholder, mortgagee, or judgment lien creditor arising prior
20to the filing of a regular notice of lien or a notice of
21jeopardy assessment lien in the office of the recorder in the
22county in which the property subject to the lien is located.
23For purposes of this Section, "bona fide" shall not include
24any mortgage of real or personal property or any other credit
25transaction that results in the mortgagee or the holder of the
26security acting as trustee for unsecured creditors of the

 

 

HB5493 Enrolled- 95 -LRB103 39189 RPS 69335 b

1company or person mentioned in the notice of lien who executed
2such chattel or real property mortgage or the document
3evidencing such credit transaction. The lien shall be inferior
4to the lien of general taxes, special assessments, and special
5taxes levied by any political subdivision of this State. In
6case title to land to be affected by the notice of lien or
7notice of jeopardy assessment lien is registered under the
8provisions of the Registered Titles (Torrens) Act, such notice
9shall be filed in the office of the Registrar of Titles of the
10county within which the property subject to the lien is
11situated and shall be entered upon the register of titles as a
12memorial or charge upon each folium of the register of titles
13affected by such notice, and the Department shall not have a
14preference over the rights of any bona fide purchaser,
15mortgagee, judgment creditor, or other lienholder arising
16prior to the registration of such notice. The regular lien or
17jeopardy assessment lien shall not be effective against any
18purchaser with respect to any item in a retailer's stock in
19trade purchased from the retailer in the usual course of the
20retailer's business.
21(Source: P.A. 102-775, eff. 5-13-22; 103-426, eff. 8-4-23.)
 
22    (215 ILCS 5/531.03)  (from Ch. 73, par. 1065.80-3)
23    Sec. 531.03. Coverage and limitations.
24    (1) This Article shall provide coverage for the policies
25and contracts specified in subsection (2) of this Section:

 

 

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1        (a) to persons who, regardless of where they reside
2    (except for non-resident certificate holders under group
3    policies or contracts), are the beneficiaries, assignees
4    or payees, including health care providers rendering
5    services covered under a health insurance policy or
6    certificate, of the persons covered under paragraph (b) of
7    this subsection, and
8        (b) to persons who are owners of or certificate
9    holders or enrollees under the policies or contracts
10    (other than unallocated annuity contracts and structured
11    settlement annuities) and in each case who:
12            (i) are residents; or
13            (ii) are not residents, but only under all of the
14        following conditions:
15                (A) the member insurer that issued the
16            policies or contracts is domiciled in this State;
17                (B) the states in which the persons reside
18            have associations similar to the Association
19            created by this Article;
20                (C) the persons are not eligible for coverage
21            by an association in any other state due to the
22            fact that the insurer or health maintenance
23            organization was not licensed in that state at the
24            time specified in that state's guaranty
25            association law.
26        (c) For unallocated annuity contracts specified in

 

 

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1    subsection (2), paragraphs (a) and (b) of this subsection
2    (1) shall not apply and this Article shall (except as
3    provided in paragraphs (e) and (f) of this subsection)
4    provide coverage to:
5            (i) persons who are the owners of the unallocated
6        annuity contracts if the contracts are issued to or in
7        connection with a specific benefit plan whose plan
8        sponsor has its principal place of business in this
9        State; and
10            (ii) persons who are owners of unallocated annuity
11        contracts issued to or in connection with government
12        lotteries if the owners are residents.
13        (d) For structured settlement annuities specified in
14    subsection (2), paragraphs (a) and (b) of this subsection
15    (1) shall not apply and this Article shall (except as
16    provided in paragraphs (e) and (f) of this subsection)
17    provide coverage to a person who is a payee under a
18    structured settlement annuity (or beneficiary of a payee
19    if the payee is deceased), if the payee:
20            (i) is a resident, regardless of where the
21        contract owner resides; or
22            (ii) is not a resident, but only under both of the
23        following conditions:
24                (A) with regard to residency:
25                    (I) the contract owner of the structured
26                settlement annuity is a resident; or

 

 

HB5493 Enrolled- 98 -LRB103 39189 RPS 69335 b

1                    (II) the contract owner of the structured
2                settlement annuity is not a resident but the
3                insurer that issued the structured settlement
4                annuity is domiciled in this State and the
5                state in which the contract owner resides has
6                an association similar to the Association
7                created by this Article; and
8                (B) neither the payee or beneficiary nor the
9            contract owner is eligible for coverage by the
10            association of the state in which the payee or
11            contract owner resides.
12        (e) This Article shall not provide coverage to:
13            (i) a person who is a payee or beneficiary of a
14        contract owner resident of this State if the payee or
15        beneficiary is afforded any coverage by the
16        association of another state; or
17            (ii) a person covered under paragraph (c) of this
18        subsection (1), if any coverage is provided by the
19        association of another state to that person.
20        (f) This Article is intended to provide coverage to a
21    person who is a resident of this State and, in special
22    circumstances, to a nonresident. In order to avoid
23    duplicate coverage, if a person who would otherwise
24    receive coverage under this Article is provided coverage
25    under the laws of any other state, then the person shall
26    not be provided coverage under this Article. In

 

 

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1    determining the application of the provisions of this
2    paragraph in situations where a person could be covered by
3    the association of more than one state, whether as an
4    owner, payee, enrollee, beneficiary, or assignee, this
5    Article shall be construed in conjunction with other state
6    laws to result in coverage by only one association.
7    (2)(a) This Article shall provide coverage to the persons
8specified in subsection (1) of this Section for policies or
9contracts of direct, (i) nongroup life insurance, health
10insurance (that, for the purposes of this Article, includes
11health maintenance organization subscriber contracts and
12certificates), annuities and supplemental contracts to any of
13these, (ii) for certificates under direct group policies or
14contracts, (iii) for unallocated annuity contracts and (iv)
15for contracts to furnish health care services and subscription
16certificates for medical or health care services issued by
17persons licensed to transact insurance business in this State
18under this Code. Annuity contracts and certificates under
19group annuity contracts include but are not limited to
20guaranteed investment contracts, deposit administration
21contracts, unallocated funding agreements, allocated funding
22agreements, structured settlement agreements, lottery
23contracts and any immediate or deferred annuity contracts.
24    (b) Except as otherwise provided in paragraph (c) of this
25subsection, this Article shall not provide coverage for:
26        (i) that portion of a policy or contract not

 

 

HB5493 Enrolled- 100 -LRB103 39189 RPS 69335 b

1    guaranteed by the member insurer, or under which the risk
2    is borne by the policy or contract owner;
3        (ii) any such policy or contract or part thereof
4    assumed by the impaired or insolvent insurer under a
5    contract of reinsurance, other than reinsurance for which
6    assumption certificates have been issued;
7        (iii) any portion of a policy or contract to the
8    extent that the rate of interest on which it is based or
9    the interest rate, crediting rate, or similar factor is
10    determined by use of an index or other external reference
11    stated in the policy or contract employed in calculating
12    returns or changes in value:
13            (A) averaged over the period of 4 years prior to
14        the date on which the member insurer becomes an
15        impaired or insolvent insurer under this Article,
16        whichever is earlier, exceeds the rate of interest
17        determined by subtracting 2 percentage points from
18        Moody's Corporate Bond Yield Average averaged for that
19        same 4-year period or for such lesser period if the
20        policy or contract was issued less than 4 years before
21        the member insurer becomes an impaired or insolvent
22        insurer under this Article, whichever is earlier; and
23            (B) on and after the date on which the member
24        insurer becomes an impaired or insolvent insurer under
25        this Article, whichever is earlier, exceeds the rate
26        of interest determined by subtracting 3 percentage

 

 

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1        points from Moody's Corporate Bond Yield Average as
2        most recently available;
3        (iv) any unallocated annuity contract issued to or in
4    connection with a benefit plan protected under the federal
5    Pension Benefit Guaranty Corporation, regardless of
6    whether the federal Pension Benefit Guaranty Corporation
7    has yet become liable to make any payments with respect to
8    the benefit plan;
9        (v) any portion of any unallocated annuity contract
10    which is not issued to or in connection with a specific
11    employee, union or association of natural persons benefit
12    plan or a government lottery;
13        (vi) an obligation that does not arise under the
14    express written terms of the policy or contract issued by
15    the member insurer to the enrollee, certificate holder,
16    contract owner, or policy owner, including without
17    limitation:
18            (A) a claim based on marketing materials;
19            (B) a claim based on side letters, riders, or
20        other documents that were issued by the member insurer
21        without meeting applicable policy or contract form
22        filing or approval requirements;
23            (C) a misrepresentation of or regarding policy or
24        contract benefits;
25            (D) an extra-contractual claim; or
26            (E) a claim for penalties or consequential or

 

 

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1        incidental damages;
2        (vii) any stop-loss insurance, as defined in clause
3    (b) of Class 1 or clause (a) of Class 2 of Section 4, and
4    further defined in subsection (d) of Section 352;
5        (viii) any policy or contract providing any hospital,
6    medical, prescription drug, or other health care benefits
7    pursuant to Part C or Part D of Subchapter XVIII, Chapter 7
8    of Title 42 of the United States Code (commonly known as
9    Medicare Part C & D), Subchapter XIX, Chapter 7 of Title 42
10    of the United States Code (commonly known as Medicaid), or
11    any regulations issued pursuant thereto;
12        (ix) any portion of a policy or contract to the extent
13    that the assessments required by Section 531.09 of this
14    Code with respect to the policy or contract are preempted
15    or otherwise not permitted by federal or State law;
16        (x) any portion of a policy or contract issued to a
17    plan or program of an employer, association, or other
18    person to provide life, health, or annuity benefits to its
19    employees, members, or others to the extent that the plan
20    or program is self-funded or uninsured, including, but not
21    limited to, benefits payable by an employer, association,
22    or other person under:
23            (A) a multiple employer welfare arrangement as
24        defined in 29 U.S.C. Section 1002;
25            (B) a minimum premium group insurance plan;
26            (C) a stop-loss group insurance plan; or

 

 

HB5493 Enrolled- 103 -LRB103 39189 RPS 69335 b

1            (D) an administrative services only contract;
2        (xi) any portion of a policy or contract to the extent
3    that it provides for:
4            (A) dividends or experience rating credits;
5            (B) voting rights; or
6            (C) payment of any fees or allowances to any
7        person, including the policy or contract owner, in
8        connection with the service to or administration of
9        the policy or contract;
10        (xii) any policy or contract issued in this State by a
11    member insurer at a time when it was not licensed or did
12    not have a certificate of authority to issue the policy or
13    contract in this State;
14        (xiii) any contractual agreement that establishes the
15    member insurer's obligations to provide a book value
16    accounting guaranty for defined contribution benefit plan
17    participants by reference to a portfolio of assets that is
18    owned by the benefit plan or its trustee, which in each
19    case is not an affiliate of the member insurer;
20        (xiv) any portion of a policy or contract to the
21    extent that it provides for interest or other changes in
22    value to be determined by the use of an index or other
23    external reference stated in the policy or contract, but
24    which have not been credited to the policy or contract, or
25    as to which the policy or contract owner's rights are
26    subject to forfeiture, as of the date the member insurer

 

 

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1    becomes an impaired or insolvent insurer under this Code,
2    whichever is earlier. If a policy's or contract's interest
3    or changes in value are credited less frequently than
4    annually, then for purposes of determining the values that
5    have been credited and are not subject to forfeiture under
6    this Section, the interest or change in value determined
7    by using the procedures defined in the policy or contract
8    will be credited as if the contractual date of crediting
9    interest or changing values was the date of impairment or
10    insolvency, whichever is earlier, and will not be subject
11    to forfeiture; or
12        (xv) that portion or part of a variable life insurance
13    or variable annuity contract not guaranteed by a member
14    insurer.
15    (c) The exclusion from coverage referenced in subdivision
16(iii) of paragraph (b) of this subsection shall not apply to
17any portion of a policy or contract, including a rider, that
18provides long-term care or other health insurance benefits.
19    (3) The benefits for which the Association may become
20liable shall in no event exceed the lesser of:
21        (a) the contractual obligations for which the member
22    insurer is liable or would have been liable if it were not
23    an impaired or insolvent insurer, or
24        (b)(i) with respect to any one life, regardless of the
25    number of policies or contracts:
26            (A) $300,000 in life insurance death benefits, but

 

 

HB5493 Enrolled- 105 -LRB103 39189 RPS 69335 b

1        not more than $100,000 in net cash surrender and net
2        cash withdrawal values for life insurance;
3            (B) for health insurance benefits:
4                (I) $100,000 for coverages not defined as
5            disability income insurance or health benefit
6            plans or long-term care insurance, including any
7            net cash surrender and net cash withdrawal values;
8                (II) $300,000 for disability income insurance
9            and $300,000 for long-term care insurance; and
10                (III) $500,000 for health benefit plans;
11            (C) $250,000 in the present value of annuity
12        benefits, including net cash surrender and net cash
13        withdrawal values;
14        (ii) with respect to each individual participating in
15    a governmental retirement benefit plan established under
16    Section 401, 403(b), or 457 of the U.S. Internal Revenue
17    Code covered by an unallocated annuity contract or the
18    beneficiaries of each such individual if deceased, in the
19    aggregate, $250,000 in present value annuity benefits,
20    including net cash surrender and net cash withdrawal
21    values;
22        (iii) with respect to each payee of a structured
23    settlement annuity or beneficiary or beneficiaries of the
24    payee if deceased, $250,000 in present value annuity
25    benefits, in the aggregate, including net cash surrender
26    and net cash withdrawal values, if any; or

 

 

HB5493 Enrolled- 106 -LRB103 39189 RPS 69335 b

1        (iv) with respect to either (1) one contract owner
2    provided coverage under subparagraph (ii) of paragraph (c)
3    of subsection (1) of this Section or (2) one plan sponsor
4    whose plans own directly or in trust one or more
5    unallocated annuity contracts not included in subparagraph
6    (ii) of paragraph (b) of this subsection, $5,000,000 in
7    benefits, irrespective of the number of contracts with
8    respect to the contract owner or plan sponsor. However, in
9    the case where one or more unallocated annuity contracts
10    are covered contracts under this Article and are owned by
11    a trust or other entity for the benefit of 2 or more plan
12    sponsors, coverage shall be afforded by the Association if
13    the largest interest in the trust or entity owning the
14    contract or contracts is held by a plan sponsor whose
15    principal place of business is in this State. In no event
16    shall the Association be obligated to cover more than
17    $5,000,000 in benefits with respect to all these
18    unallocated contracts.
19    In no event shall the Association be obligated to cover
20more than (1) an aggregate of $300,000 in benefits with
21respect to any one life under subparagraphs (i), (ii), and
22(iii) of this paragraph (b) except with respect to benefits
23for health benefit plans under item (B) of subparagraph (i) of
24this paragraph (b), in which case the aggregate liability of
25the Association shall not exceed $500,000 with respect to any
26one individual or (2) with respect to one owner of multiple

 

 

HB5493 Enrolled- 107 -LRB103 39189 RPS 69335 b

1nongroup policies of life insurance, whether the policy or
2contract owner is an individual, firm, corporation, or other
3person and whether the persons insured are officers, managers,
4employees, or other persons, $5,000,000 in benefits,
5regardless of the number of policies and contracts held by the
6owner.
7    The limitations set forth in this subsection are
8limitations on the benefits for which the Association is
9obligated before taking into account either its subrogation
10and assignment rights or the extent to which those benefits
11could be provided out of the assets of the impaired or
12insolvent insurer attributable to covered policies. The costs
13of the Association's obligations under this Article may be met
14by the use of assets attributable to covered policies or
15reimbursed to the Association pursuant to its subrogation and
16assignment rights.
17    For purposes of this Article, benefits provided by a
18long-term care rider to a life insurance policy or annuity
19contract shall be considered the same type of benefits as the
20base life insurance policy or annuity contract to which it
21relates.
22    (4) In performing its obligations to provide coverage
23under Section 531.08 of this Code, the Association shall not
24be required to guarantee, assume, reinsure, reissue, or
25perform or cause to be guaranteed, assumed, reinsured,
26reissued, or performed the contractual obligations of the

 

 

HB5493 Enrolled- 108 -LRB103 39189 RPS 69335 b

1insolvent or impaired insurer under a covered policy or
2contract that do not materially affect the economic values or
3economic benefits of the covered policy or contract.
4(Source: P.A. 100-687, eff. 8-3-18; 100-863, eff. 8-14-18.)
 
5    (215 ILCS 5/356z.30a rep.)
6    (215 ILCS 5/362a rep.)
7    Section 26. The Illinois Insurance Code is amended by
8repealing Sections 356z.30a and 362a.
 
9    Section 30. The Network Adequacy and Transparency Act is
10amended by changing Sections 5 and 10 as follows:
 
11    (215 ILCS 124/5)
12    Sec. 5. Definitions. In this Act:
13    "Authorized representative" means a person to whom a
14beneficiary has given express written consent to represent the
15beneficiary; a person authorized by law to provide substituted
16consent for a beneficiary; or the beneficiary's treating
17provider only when the beneficiary or his or her family member
18is unable to provide consent.
19    "Beneficiary" means an individual, an enrollee, an
20insured, a participant, or any other person entitled to
21reimbursement for covered expenses of or the discounting of
22provider fees for health care services under a program in
23which the beneficiary has an incentive to utilize the services

 

 

HB5493 Enrolled- 109 -LRB103 39189 RPS 69335 b

1of a provider that has entered into an agreement or
2arrangement with an insurer.
3    "Department" means the Department of Insurance.
4    "Director" means the Director of Insurance.
5    "Family caregiver" means a relative, partner, friend, or
6neighbor who has a significant relationship with the patient
7and administers or assists the patient with activities of
8daily living, instrumental activities of daily living, or
9other medical or nursing tasks for the quality and welfare of
10that patient.
11    "Insurer" means any entity that offers individual or group
12accident and health insurance, including, but not limited to,
13health maintenance organizations, preferred provider
14organizations, exclusive provider organizations, and other
15plan structures requiring network participation, excluding the
16medical assistance program under the Illinois Public Aid Code,
17the State employees group health insurance program, workers
18compensation insurance, and pharmacy benefit managers.
19    "Material change" means a significant reduction in the
20number of providers available in a network plan, including,
21but not limited to, a reduction of 10% or more in a specific
22type of providers, the removal of a major health system that
23causes a network to be significantly different from the
24network when the beneficiary purchased the network plan, or
25any change that would cause the network to no longer satisfy
26the requirements of this Act or the Department's rules for

 

 

HB5493 Enrolled- 110 -LRB103 39189 RPS 69335 b

1network adequacy and transparency.
2    "Network" means the group or groups of preferred providers
3providing services to a network plan.
4    "Network plan" means an individual or group policy of
5accident and health insurance that either requires a covered
6person to use or creates incentives, including financial
7incentives, for a covered person to use providers managed,
8owned, under contract with, or employed by the insurer.
9    "Ongoing course of treatment" means (1) treatment for a
10life-threatening condition, which is a disease or condition
11for which likelihood of death is probable unless the course of
12the disease or condition is interrupted; (2) treatment for a
13serious acute condition, defined as a disease or condition
14requiring complex ongoing care that the covered person is
15currently receiving, such as chemotherapy, radiation therapy,
16or post-operative visits; (3) a course of treatment for a
17health condition that a treating provider attests that
18discontinuing care by that provider would worsen the condition
19or interfere with anticipated outcomes; or (4) the third
20trimester of pregnancy through the post-partum period.
21    "Preferred provider" means any provider who has entered,
22either directly or indirectly, into an agreement with an
23employer or risk-bearing entity relating to health care
24services that may be rendered to beneficiaries under a network
25plan.
26    "Providers" means physicians licensed to practice medicine

 

 

HB5493 Enrolled- 111 -LRB103 39189 RPS 69335 b

1in all its branches, other health care professionals,
2hospitals, or other health care institutions that provide
3health care services.
4    "Telehealth" has the meaning given to that term in Section
5356z.22 of the Illinois Insurance Code.
6    "Telemedicine" has the meaning given to that term in
7Section 49.5 of the Medical Practice Act of 1987.
8    "Tiered network" means a network that identifies and
9groups some or all types of provider and facilities into
10specific groups to which different provider reimbursement,
11covered person cost-sharing or provider access requirements,
12or any combination thereof, apply for the same services.
13    "Woman's principal health care provider" means a physician
14licensed to practice medicine in all of its branches
15specializing in obstetrics, gynecology, or family practice.
16(Source: P.A. 102-92, eff. 7-9-21; 102-813, eff. 5-13-22.)
 
17    (215 ILCS 124/10)
18    Sec. 10. Network adequacy.
19    (a) An insurer providing a network plan shall file a
20description of all of the following with the Director:
21        (1) The written policies and procedures for adding
22    providers to meet patient needs based on increases in the
23    number of beneficiaries, changes in the
24    patient-to-provider ratio, changes in medical and health
25    care capabilities, and increased demand for services.

 

 

HB5493 Enrolled- 112 -LRB103 39189 RPS 69335 b

1        (2) The written policies and procedures for making
2    referrals within and outside the network.
3        (3) The written policies and procedures on how the
4    network plan will provide 24-hour, 7-day per week access
5    to network-affiliated primary care, emergency services,
6    and obstetrical and gynecological health care
7    professionals women's principal health care providers.
8    An insurer shall not prohibit a preferred provider from
9discussing any specific or all treatment options with
10beneficiaries irrespective of the insurer's position on those
11treatment options or from advocating on behalf of
12beneficiaries within the utilization review, grievance, or
13appeals processes established by the insurer in accordance
14with any rights or remedies available under applicable State
15or federal law.
16    (b) Insurers must file for review a description of the
17services to be offered through a network plan. The description
18shall include all of the following:
19        (1) A geographic map of the area proposed to be served
20    by the plan by county service area and zip code, including
21    marked locations for preferred providers.
22        (2) As deemed necessary by the Department, the names,
23    addresses, phone numbers, and specialties of the providers
24    who have entered into preferred provider agreements under
25    the network plan.
26        (3) The number of beneficiaries anticipated to be

 

 

HB5493 Enrolled- 113 -LRB103 39189 RPS 69335 b

1    covered by the network plan.
2        (4) An Internet website and toll-free telephone number
3    for beneficiaries and prospective beneficiaries to access
4    current and accurate lists of preferred providers,
5    additional information about the plan, as well as any
6    other information required by Department rule.
7        (5) A description of how health care services to be
8    rendered under the network plan are reasonably accessible
9    and available to beneficiaries. The description shall
10    address all of the following:
11            (A) the type of health care services to be
12        provided by the network plan;
13            (B) the ratio of physicians and other providers to
14        beneficiaries, by specialty and including primary care
15        physicians and facility-based physicians when
16        applicable under the contract, necessary to meet the
17        health care needs and service demands of the currently
18        enrolled population;
19            (C) the travel and distance standards for plan
20        beneficiaries in county service areas; and
21            (D) a description of how the use of telemedicine,
22        telehealth, or mobile care services may be used to
23        partially meet the network adequacy standards, if
24        applicable.
25        (6) A provision ensuring that whenever a beneficiary
26    has made a good faith effort, as evidenced by accessing

 

 

HB5493 Enrolled- 114 -LRB103 39189 RPS 69335 b

1    the provider directory, calling the network plan, and
2    calling the provider, to utilize preferred providers for a
3    covered service and it is determined the insurer does not
4    have the appropriate preferred providers due to
5    insufficient number, type, unreasonable travel distance or
6    delay, or preferred providers refusing to provide a
7    covered service because it is contrary to the conscience
8    of the preferred providers, as protected by the Health
9    Care Right of Conscience Act, the insurer shall ensure,
10    directly or indirectly, by terms contained in the payer
11    contract, that the beneficiary will be provided the
12    covered service at no greater cost to the beneficiary than
13    if the service had been provided by a preferred provider.
14    This paragraph (6) does not apply to: (A) a beneficiary
15    who willfully chooses to access a non-preferred provider
16    for health care services available through the panel of
17    preferred providers, or (B) a beneficiary enrolled in a
18    health maintenance organization. In these circumstances,
19    the contractual requirements for non-preferred provider
20    reimbursements shall apply unless Section 356z.3a of the
21    Illinois Insurance Code requires otherwise. In no event
22    shall a beneficiary who receives care at a participating
23    health care facility be required to search for
24    participating providers under the circumstances described
25    in subsection (b) or (b-5) of Section 356z.3a of the
26    Illinois Insurance Code except under the circumstances

 

 

HB5493 Enrolled- 115 -LRB103 39189 RPS 69335 b

1    described in paragraph (2) of subsection (b-5).
2        (7) A provision that the beneficiary shall receive
3    emergency care coverage such that payment for this
4    coverage is not dependent upon whether the emergency
5    services are performed by a preferred or non-preferred
6    provider and the coverage shall be at the same benefit
7    level as if the service or treatment had been rendered by a
8    preferred provider. For purposes of this paragraph (7),
9    "the same benefit level" means that the beneficiary is
10    provided the covered service at no greater cost to the
11    beneficiary than if the service had been provided by a
12    preferred provider. This provision shall be consistent
13    with Section 356z.3a of the Illinois Insurance Code.
14        (8) A limitation that, if the plan provides that the
15    beneficiary will incur a penalty for failing to
16    pre-certify inpatient hospital treatment, the penalty may
17    not exceed $1,000 per occurrence in addition to the plan
18    cost-sharing cost sharing provisions.
19    (c) The network plan shall demonstrate to the Director a
20minimum ratio of providers to plan beneficiaries as required
21by the Department.
22        (1) The ratio of physicians or other providers to plan
23    beneficiaries shall be established annually by the
24    Department in consultation with the Department of Public
25    Health based upon the guidance from the federal Centers
26    for Medicare and Medicaid Services. The Department shall

 

 

HB5493 Enrolled- 116 -LRB103 39189 RPS 69335 b

1    not establish ratios for vision or dental providers who
2    provide services under dental-specific or vision-specific
3    benefits. The Department shall consider establishing
4    ratios for the following physicians or other providers:
5            (A) Primary Care;
6            (B) Pediatrics;
7            (C) Cardiology;
8            (D) Gastroenterology;
9            (E) General Surgery;
10            (F) Neurology;
11            (G) OB/GYN;
12            (H) Oncology/Radiation;
13            (I) Ophthalmology;
14            (J) Urology;
15            (K) Behavioral Health;
16            (L) Allergy/Immunology;
17            (M) Chiropractic;
18            (N) Dermatology;
19            (O) Endocrinology;
20            (P) Ears, Nose, and Throat (ENT)/Otolaryngology;
21            (Q) Infectious Disease;
22            (R) Nephrology;
23            (S) Neurosurgery;
24            (T) Orthopedic Surgery;
25            (U) Physiatry/Rehabilitative;
26            (V) Plastic Surgery;

 

 

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1            (W) Pulmonary;
2            (X) Rheumatology;
3            (Y) Anesthesiology;
4            (Z) Pain Medicine;
5            (AA) Pediatric Specialty Services;
6            (BB) Outpatient Dialysis; and
7            (CC) HIV.
8        (2) The Director shall establish a process for the
9    review of the adequacy of these standards, along with an
10    assessment of additional specialties to be included in the
11    list under this subsection (c).
12    (d) The network plan shall demonstrate to the Director
13maximum travel and distance standards for plan beneficiaries,
14which shall be established annually by the Department in
15consultation with the Department of Public Health based upon
16the guidance from the federal Centers for Medicare and
17Medicaid Services. These standards shall consist of the
18maximum minutes or miles to be traveled by a plan beneficiary
19for each county type, such as large counties, metro counties,
20or rural counties as defined by Department rule.
21    The maximum travel time and distance standards must
22include standards for each physician and other provider
23category listed for which ratios have been established.
24    The Director shall establish a process for the review of
25the adequacy of these standards along with an assessment of
26additional specialties to be included in the list under this

 

 

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1subsection (d).
2    (d-5)(1) Every insurer shall ensure that beneficiaries
3have timely and proximate access to treatment for mental,
4emotional, nervous, or substance use disorders or conditions
5in accordance with the provisions of paragraph (4) of
6subsection (a) of Section 370c of the Illinois Insurance Code.
7Insurers shall use a comparable process, strategy, evidentiary
8standard, and other factors in the development and application
9of the network adequacy standards for timely and proximate
10access to treatment for mental, emotional, nervous, or
11substance use disorders or conditions and those for the access
12to treatment for medical and surgical conditions. As such, the
13network adequacy standards for timely and proximate access
14shall equally be applied to treatment facilities and providers
15for mental, emotional, nervous, or substance use disorders or
16conditions and specialists providing medical or surgical
17benefits pursuant to the parity requirements of Section 370c.1
18of the Illinois Insurance Code and the federal Paul Wellstone
19and Pete Domenici Mental Health Parity and Addiction Equity
20Act of 2008. Notwithstanding the foregoing, the network
21adequacy standards for timely and proximate access to
22treatment for mental, emotional, nervous, or substance use
23disorders or conditions shall, at a minimum, satisfy the
24following requirements:
25        (A) For beneficiaries residing in the metropolitan
26    counties of Cook, DuPage, Kane, Lake, McHenry, and Will,

 

 

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1    network adequacy standards for timely and proximate access
2    to treatment for mental, emotional, nervous, or substance
3    use disorders or conditions means a beneficiary shall not
4    have to travel longer than 30 minutes or 30 miles from the
5    beneficiary's residence to receive outpatient treatment
6    for mental, emotional, nervous, or substance use disorders
7    or conditions. Beneficiaries shall not be required to wait
8    longer than 10 business days between requesting an initial
9    appointment and being seen by the facility or provider of
10    mental, emotional, nervous, or substance use disorders or
11    conditions for outpatient treatment or to wait longer than
12    20 business days between requesting a repeat or follow-up
13    appointment and being seen by the facility or provider of
14    mental, emotional, nervous, or substance use disorders or
15    conditions for outpatient treatment; however, subject to
16    the protections of paragraph (3) of this subsection, a
17    network plan shall not be held responsible if the
18    beneficiary or provider voluntarily chooses to schedule an
19    appointment outside of these required time frames.
20        (B) For beneficiaries residing in Illinois counties
21    other than those counties listed in subparagraph (A) of
22    this paragraph, network adequacy standards for timely and
23    proximate access to treatment for mental, emotional,
24    nervous, or substance use disorders or conditions means a
25    beneficiary shall not have to travel longer than 60
26    minutes or 60 miles from the beneficiary's residence to

 

 

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1    receive outpatient treatment for mental, emotional,
2    nervous, or substance use disorders or conditions.
3    Beneficiaries shall not be required to wait longer than 10
4    business days between requesting an initial appointment
5    and being seen by the facility or provider of mental,
6    emotional, nervous, or substance use disorders or
7    conditions for outpatient treatment or to wait longer than
8    20 business days between requesting a repeat or follow-up
9    appointment and being seen by the facility or provider of
10    mental, emotional, nervous, or substance use disorders or
11    conditions for outpatient treatment; however, subject to
12    the protections of paragraph (3) of this subsection, a
13    network plan shall not be held responsible if the
14    beneficiary or provider voluntarily chooses to schedule an
15    appointment outside of these required time frames.
16    (2) For beneficiaries residing in all Illinois counties,
17network adequacy standards for timely and proximate access to
18treatment for mental, emotional, nervous, or substance use
19disorders or conditions means a beneficiary shall not have to
20travel longer than 60 minutes or 60 miles from the
21beneficiary's residence to receive inpatient or residential
22treatment for mental, emotional, nervous, or substance use
23disorders or conditions.
24    (3) If there is no in-network facility or provider
25available for a beneficiary to receive timely and proximate
26access to treatment for mental, emotional, nervous, or

 

 

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1substance use disorders or conditions in accordance with the
2network adequacy standards outlined in this subsection, the
3insurer shall provide necessary exceptions to its network to
4ensure admission and treatment with a provider or at a
5treatment facility in accordance with the network adequacy
6standards in this subsection.
7    (e) Except for network plans solely offered as a group
8health plan, these ratio and time and distance standards apply
9to the lowest cost-sharing tier of any tiered network.
10    (f) The network plan may consider use of other health care
11service delivery options, such as telemedicine or telehealth,
12mobile clinics, and centers of excellence, or other ways of
13delivering care to partially meet the requirements set under
14this Section.
15    (g) Except for the requirements set forth in subsection
16(d-5), insurers who are not able to comply with the provider
17ratios and time and distance standards established by the
18Department may request an exception to these requirements from
19the Department. The Department may grant an exception in the
20following circumstances:
21        (1) if no providers or facilities meet the specific
22    time and distance standard in a specific service area and
23    the insurer (i) discloses information on the distance and
24    travel time points that beneficiaries would have to travel
25    beyond the required criterion to reach the next closest
26    contracted provider outside of the service area and (ii)

 

 

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1    provides contact information, including names, addresses,
2    and phone numbers for the next closest contracted provider
3    or facility;
4        (2) if patterns of care in the service area do not
5    support the need for the requested number of provider or
6    facility type and the insurer provides data on local
7    patterns of care, such as claims data, referral patterns,
8    or local provider interviews, indicating where the
9    beneficiaries currently seek this type of care or where
10    the physicians currently refer beneficiaries, or both; or
11        (3) other circumstances deemed appropriate by the
12    Department consistent with the requirements of this Act.
13    (h) Insurers are required to report to the Director any
14material change to an approved network plan within 15 days
15after the change occurs and any change that would result in
16failure to meet the requirements of this Act. Upon notice from
17the insurer, the Director shall reevaluate the network plan's
18compliance with the network adequacy and transparency
19standards of this Act.
20(Source: P.A. 102-144, eff. 1-1-22; 102-901, eff. 7-1-22;
21102-1117, eff. 1-13-23.)
 
22    Section 35. The Health Maintenance Organization Act is
23amended by changing Sections 4.5-1, 5-3, and 5-3.1 as follows:
 
24    (215 ILCS 125/4.5-1)

 

 

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1    Sec. 4.5-1. Point-of-service health service contracts.
2    (a) A health maintenance organization that offers a
3point-of-service contract:
4        (1) must include as in-plan covered services all
5    services required by law to be provided by a health
6    maintenance organization;
7        (2) must provide incentives, which shall include
8    financial incentives, for enrollees to use in-plan covered
9    services;
10        (3) may not offer services out-of-plan without
11    providing those services on an in-plan basis;
12        (4) may include annual out-of-pocket limits and
13    lifetime maximum benefits allowances for out-of-plan
14    services that are separate from any limits or allowances
15    applied to in-plan services;
16        (5) may not consider emergency services, authorized
17    referral services, or non-routine services obtained out of
18    the service area to be point-of-service services;
19        (6) may treat as out-of-plan services those services
20    that an enrollee obtains from a participating provider,
21    but for which the proper authorization was not given by
22    the health maintenance organization; and
23        (7) after January 1, 2003 (the effective date of
24    Public Act 92-579), must include the following disclosure
25    on its point-of-service contracts and evidences of
26    coverage: "WARNING, LIMITED BENEFITS WILL BE PAID WHEN

 

 

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

 

 

HB5493 Enrolled- 125 -LRB103 39189 RPS 69335 b

1    COINSURANCE AMOUNT DEFINED IN THE POLICY AFTER THE PLAN
2    HAS PAID ITS REQUIRED PORTION. Non-participating providers
3    may bill members for any amount up to the billed charge
4    after the plan has paid its portion of the bill, except as
5    provided in Section 356z.3a of the Illinois Insurance Code
6    for covered services received at a participating health
7    care facility from a non-participating provider that are:
8    (a) ancillary services, (b) items or services furnished as
9    a result of unforeseen, urgent medical needs that arise at
10    the time the item or service is furnished, or (c) items or
11    services received when the facility or the
12    non-participating provider fails to satisfy the notice and
13    consent criteria specified under Section 356z.3a.
14    Participating providers have agreed to accept discounted
15    payments for services with no additional billing to the
16    member other than co-insurance and deductible amounts. You
17    may obtain further information about the participating
18    status of professional providers and information on
19    out-of-pocket expenses by calling the toll-free toll free
20    telephone number on your identification card.".
21    (b) A health maintenance organization offering a
22point-of-service contract is subject to all of the following
23limitations:
24        (1) The health maintenance organization may not expend
25    in any calendar quarter more than 20% of its total
26    expenditures for all its members for out-of-plan covered

 

 

HB5493 Enrolled- 126 -LRB103 39189 RPS 69335 b

1    services.
2        (2) If the amount specified in item (1) of this
3    subsection is exceeded by 2% in a quarter, the health
4    maintenance organization must effect compliance with item
5    (1) of this subsection by the end of the following
6    quarter.
7        (3) If compliance with the amount specified in item
8    (1) of this subsection is not demonstrated in the health
9    maintenance organization's next quarterly report, the
10    health maintenance organization may not offer the
11    point-of-service contract to new groups or include the
12    point-of-service option in the renewal of an existing
13    group until compliance with the amount specified in item
14    (1) of this subsection is demonstrated or until otherwise
15    allowed by the Director.
16        (4) A health maintenance organization failing, without
17    just cause, to comply with the provisions of this
18    subsection shall be required, after notice and hearing, to
19    pay a penalty of $250 for each day out of compliance, to be
20    recovered by the Director. Any penalty recovered shall be
21    paid into the General Revenue Fund. The Director may
22    reduce the penalty if the health maintenance organization
23    demonstrates to the Director that the imposition of the
24    penalty would constitute a financial hardship to the
25    health maintenance organization.
26    (c) A health maintenance organization that offers a

 

 

HB5493 Enrolled- 127 -LRB103 39189 RPS 69335 b

1point-of-service product must do all of the following:
2        (1) File a quarterly financial statement detailing
3    compliance with the requirements of subsection (b).
4        (2) Track out-of-plan, point-of-service utilization
5    separately from in-plan or non-point-of-service,
6    out-of-plan emergency care, referral care, and urgent care
7    out of the service area utilization.
8        (3) Record out-of-plan utilization in a manner that
9    will permit such utilization and cost reporting as the
10    Director may, by rule, require.
11        (4) Demonstrate to the Director's satisfaction that
12    the health maintenance organization has the fiscal,
13    administrative, and marketing capacity to control its
14    point-of-service enrollment, utilization, and costs so as
15    not to jeopardize the financial security of the health
16    maintenance organization.
17        (5) Maintain, in addition to any other deposit
18    required under this Act, the deposit required by Section
19    2-6.
20        (6) Maintain cash and cash equivalents of sufficient
21    amount to fully liquidate 10 days' average claim payments,
22    subject to review by the Director.
23        (7) Maintain and file with the Director, reinsurance
24    coverage protecting against catastrophic losses on
25    out-of-network point-of-service services. Deductibles may
26    not exceed $100,000 per covered life per year, and the

 

 

HB5493 Enrolled- 128 -LRB103 39189 RPS 69335 b

1    portion of risk retained by the health maintenance
2    organization once deductibles have been satisfied may not
3    exceed 20%. Reinsurance must be placed with licensed
4    authorized reinsurers qualified to do business in this
5    State.
6    (d) A health maintenance organization may not issue a
7point-of-service contract until it has filed and had approved
8by the Director a plan to comply with the provisions of this
9Section. The compliance plan must, at a minimum, include
10provisions demonstrating that the health maintenance
11organization will do all of the following:
12        (1) Design the benefit levels and conditions of
13    coverage for in-plan covered services and out-of-plan
14    covered services as required by this Article.
15        (2) Provide or arrange for the provision of adequate
16    systems to:
17            (A) process and pay claims for all out-of-plan
18        covered services;
19            (B) meet the requirements for point-of-service
20        contracts set forth in this Section and any additional
21        requirements that may be set forth by the Director;
22        and
23            (C) generate accurate data and financial and
24        regulatory reports on a timely basis so that the
25        Department of Insurance can evaluate the health
26        maintenance organization's experience with the

 

 

HB5493 Enrolled- 129 -LRB103 39189 RPS 69335 b

1        point-of-service contract and monitor compliance with
2        point-of-service contract provisions.
3        (3) Comply with the requirements of subsections (b)
4    and (c).
5(Source: P.A. 102-901, eff. 1-1-23; 103-154, eff. 6-30-23.)
 
6    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
7    Sec. 5-3. Insurance Code provisions.
8    (a) Health Maintenance Organizations shall be subject to
9the provisions of Sections 133, 134, 136, 137, 139, 140,
10141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
11154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49,
12355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356v,
13356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
14356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
15356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21, 356z.22,
16356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29, 356z.30,
17356z.30a, 356z.31, 356z.32, 356z.33, 356z.34, 356z.35,
18356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41, 356z.44,
19356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50, 356z.51,
20356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58, 356z.59,
21356z.60, 356z.61, 356z.62, 356z.63, 356z.64, 356z.65, 356z.66,
22356z.67, 356z.68, 356z.69, 356z.70, 364, 364.01, 364.3, 367.2,
23367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370c, 370c.1,
24401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, and
25444.1, paragraph (c) of subsection (2) of Section 367, and

 

 

HB5493 Enrolled- 130 -LRB103 39189 RPS 69335 b

1Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV,
2XXVI, and XXXIIB of the Illinois Insurance Code.
3    (b) For purposes of the Illinois Insurance Code, except
4for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
5Health Maintenance Organizations in the following categories
6are deemed to be "domestic companies":
7        (1) a corporation authorized under the Dental Service
8    Plan Act or the Voluntary Health Services Plans Act;
9        (2) a corporation organized under the laws of this
10    State; or
11        (3) a corporation organized under the laws of another
12    state, 30% or more of the enrollees of which are residents
13    of this State, except a corporation subject to
14    substantially the same requirements in its state of
15    organization as is a "domestic company" under Article VIII
16    1/2 of the Illinois Insurance Code.
17    (c) In considering the merger, consolidation, or other
18acquisition of control of a Health Maintenance Organization
19pursuant to Article VIII 1/2 of the Illinois Insurance Code,
20        (1) the Director shall give primary consideration to
21    the continuation of benefits to enrollees and the
22    financial conditions of the acquired Health Maintenance
23    Organization after the merger, consolidation, or other
24    acquisition of control takes effect;
25        (2)(i) the criteria specified in subsection (1)(b) of
26    Section 131.8 of the Illinois Insurance Code shall not

 

 

HB5493 Enrolled- 131 -LRB103 39189 RPS 69335 b

1    apply and (ii) the Director, in making his determination
2    with respect to the merger, consolidation, or other
3    acquisition of control, need not take into account the
4    effect on competition of the merger, consolidation, or
5    other acquisition of control;
6        (3) the Director shall have the power to require the
7    following information:
8            (A) certification by an independent actuary of the
9        adequacy of the reserves of the Health Maintenance
10        Organization sought to be acquired;
11            (B) pro forma financial statements reflecting the
12        combined balance sheets of the acquiring company and
13        the Health Maintenance Organization sought to be
14        acquired as of the end of the preceding year and as of
15        a date 90 days prior to the acquisition, as well as pro
16        forma financial statements reflecting projected
17        combined operation for a period of 2 years;
18            (C) a pro forma business plan detailing an
19        acquiring party's plans with respect to the operation
20        of the Health Maintenance Organization sought to be
21        acquired for a period of not less than 3 years; and
22            (D) such other information as the Director shall
23        require.
24    (d) The provisions of Article VIII 1/2 of the Illinois
25Insurance Code and this Section 5-3 shall apply to the sale by
26any health maintenance organization of greater than 10% of its

 

 

HB5493 Enrolled- 132 -LRB103 39189 RPS 69335 b

1enrollee population (including, without limitation, the health
2maintenance organization's right, title, and interest in and
3to its health care certificates).
4    (e) In considering any management contract or service
5agreement subject to Section 141.1 of the Illinois Insurance
6Code, the Director (i) shall, in addition to the criteria
7specified in Section 141.2 of the Illinois Insurance Code,
8take into account the effect of the management contract or
9service agreement on the continuation of benefits to enrollees
10and the financial condition of the health maintenance
11organization to be managed or serviced, and (ii) need not take
12into account the effect of the management contract or service
13agreement on competition.
14    (f) Except for small employer groups as defined in the
15Small Employer Rating, Renewability and Portability Health
16Insurance Act and except for medicare supplement policies as
17defined in Section 363 of the Illinois Insurance Code, a
18Health Maintenance Organization may by contract agree with a
19group or other enrollment unit to effect refunds or charge
20additional premiums under the following terms and conditions:
21        (i) the amount of, and other terms and conditions with
22    respect to, the refund or additional premium are set forth
23    in the group or enrollment unit contract agreed in advance
24    of the period for which a refund is to be paid or
25    additional premium is to be charged (which period shall
26    not be less than one year); and

 

 

HB5493 Enrolled- 133 -LRB103 39189 RPS 69335 b

1        (ii) the amount of the refund or additional premium
2    shall not exceed 20% of the Health Maintenance
3    Organization's profitable or unprofitable experience with
4    respect to the group or other enrollment unit for the
5    period (and, for purposes of a refund or additional
6    premium, the profitable or unprofitable experience shall
7    be calculated taking into account a pro rata share of the
8    Health Maintenance Organization's administrative and
9    marketing expenses, but shall not include any refund to be
10    made or additional premium to be paid pursuant to this
11    subsection (f)). The Health Maintenance Organization and
12    the group or enrollment unit may agree that the profitable
13    or unprofitable experience may be calculated taking into
14    account the refund period and the immediately preceding 2
15    plan years.
16    The Health Maintenance Organization shall include a
17statement in the evidence of coverage issued to each enrollee
18describing the possibility of a refund or additional premium,
19and upon request of any group or enrollment unit, provide to
20the group or enrollment unit a description of the method used
21to calculate (1) the Health Maintenance Organization's
22profitable experience with respect to the group or enrollment
23unit and the resulting refund to the group or enrollment unit
24or (2) the Health Maintenance Organization's unprofitable
25experience with respect to the group or enrollment unit and
26the resulting additional premium to be paid by the group or

 

 

HB5493 Enrolled- 134 -LRB103 39189 RPS 69335 b

1enrollment unit.
2    In no event shall the Illinois Health Maintenance
3Organization Guaranty Association be liable to pay any
4contractual obligation of an insolvent organization to pay any
5refund authorized under this Section.
6    (g) Rulemaking authority to implement Public Act 95-1045,
7if any, is conditioned on the rules being adopted in
8accordance with all provisions of the Illinois Administrative
9Procedure Act and all rules and procedures of the Joint
10Committee on Administrative Rules; any purported rule not so
11adopted, for whatever reason, is unauthorized.
12(Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
13102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
141-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
15eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
16102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
171-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
18eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
19103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
206-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
21eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.)
 
22    (215 ILCS 125/5-3.1)
23    Sec. 5-3.1. Access to obstetrical and gynecological care
24Woman's health care provider. Health maintenance organizations
25are subject to the provisions of Section 356r of the Illinois

 

 

HB5493 Enrolled- 135 -LRB103 39189 RPS 69335 b

1Insurance Code.
2(Source: P.A. 89-514, eff. 7-17-96.)
 
3    Section 40. The Limited Health Service Organization Act is
4amended by changing Sections 4002.1 and 4003 as follows:
 
5    (215 ILCS 130/4002.1)
6    Sec. 4002.1. Access to obstetrical and gynecological care
7Woman's health care provider. Limited health service
8organizations are subject to the provisions of Section 356r of
9the Illinois Insurance Code.
10(Source: P.A. 89-514, eff. 7-17-96.)
 
11    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
12    Sec. 4003. Illinois Insurance Code provisions. Limited
13health service organizations shall be subject to the
14provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
15141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
16154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 355.2,
17355.3, 355b, 356q, 356v, 356z.4, 356z.4a, 356z.10, 356z.21,
18356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32,
19356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
20356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 364.3,
21368a, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444,
22and 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII
231/2, XXV, and XXVI of the Illinois Insurance Code. Nothing in

 

 

HB5493 Enrolled- 136 -LRB103 39189 RPS 69335 b

1this Section shall require a limited health care plan to cover
2any service that is not a limited health service. For purposes
3of the Illinois Insurance Code, except for Sections 444 and
4444.1 and Articles XIII and XIII 1/2, limited health service
5organizations in the following categories are deemed to be
6domestic companies:
7        (1) a corporation under the laws of this State; or
8        (2) a corporation organized under the laws of another
9    state, 30% or more of the enrollees of which are residents
10    of this State, except a corporation subject to
11    substantially the same requirements in its state of
12    organization as is a domestic company under Article VIII
13    1/2 of the Illinois Insurance Code.
14(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
15102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
161-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,
17eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
18102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
191-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
20eff. 1-1-24; revised 8-29-23.)
 
21    Section 43. The Voluntary Health Services Plans Act is
22amended by changing Section 10 as follows:
 
23    (215 ILCS 165/10)  (from Ch. 32, par. 604)
24    Sec. 10. Application of Insurance Code provisions. Health

 

 

HB5493 Enrolled- 137 -LRB103 39189 RPS 69335 b

1services plan corporations and all persons interested therein
2or dealing therewith shall be subject to the provisions of
3Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
4143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
5356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w,
6356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5,
7356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
8356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
9356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
10356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
11356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64,
12356z.67, 356z.68, 364.01, 364.3, 367.2, 368a, 401, 401.1, 402,
13403, 403A, 408, 408.2, and 412, and paragraphs (7) and (15) of
14Section 367 of the Illinois Insurance Code.
15    Rulemaking authority to implement Public Act 95-1045, if
16any, is conditioned on the rules being adopted in accordance
17with all provisions of the Illinois Administrative Procedure
18Act and all rules and procedures of the Joint Committee on
19Administrative Rules; any purported rule not so adopted, for
20whatever reason, is unauthorized.
21(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
22102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
2310-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
24eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
25102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
261-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,

 

 

HB5493 Enrolled- 138 -LRB103 39189 RPS 69335 b

1eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
2103-551, eff. 8-11-23; revised 8-29-23.)
 
3    Section 45. The Illinois Public Aid Code is amended by
4changing Section 5-16.9 as follows:
 
5    (305 ILCS 5/5-16.9)
6    Sec. 5-16.9. Access to obstetrical and gynecological care
7Woman's health care provider. The medical assistance program
8is subject to the provisions of Section 356r of the Illinois
9Insurance Code. The Illinois Department shall adopt rules to
10implement the requirements of Section 356r of the Illinois
11Insurance Code in the medical assistance program including
12managed care components.
13    On and after July 1, 2012, the Department shall reduce any
14rate of reimbursement for services or other payments or alter
15any methodologies authorized by this Code to reduce any rate
16of reimbursement for services or other payments in accordance
17with Section 5-5e.
18(Source: P.A. 97-689, eff. 6-14-12.)
 
19    Section 95. No acceleration or delay. Where this Act makes
20changes in a statute that is represented in this Act by text
21that is not yet or no longer in effect (for example, a Section
22represented by multiple versions), the use of that text does
23not accelerate or delay the taking effect of (i) the changes

 

 

HB5493 Enrolled- 139 -LRB103 39189 RPS 69335 b

1made by this Act or (ii) provisions derived from any other
2Public Act.
 
3    Section 99. Effective date. This Act takes effect upon
4becoming law, except that the changes to Sections 356r, 356s,
5356z.3, and 367a of the Illinois Insurance Code and Section
64.5-1 of the Health Maintenance Organization Act take effect
7January 1, 2025.