Public Act 103-0751
 
SB0773 EnrolledLRB103 03229 AMQ 48235 b

    AN ACT concerning regulation.
 
    Be it enacted by the People of the State of Illinois, 
represented in the General Assembly: 
 
    Section 5. The State Employees Group Insurance Act of 1971 
is amended by changing Sections 6.11 and 6.11B as follows:
 
    (5 ILCS 375/6.11)
    Sec. 6.11. Required health benefits; Illinois Insurance 
Code requirements. The program of health benefits shall 
provide the post-mastectomy care benefits required to be 
covered by a policy of accident and health insurance under 
Section 356t of the Illinois Insurance Code. The program of 
health benefits shall provide the coverage required under 
Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x, 
356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 
356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22, 
356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, 
356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51, 
356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, 356z.60, 
and 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, 356z.70, 
and 356z.71 of the Illinois Insurance Code. The program of 
health benefits must comply with Sections 155.22a, 155.37, 
355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of the 
Illinois Insurance Code. The program of health benefits shall 
provide the coverage required under Section 356m of the 
Illinois Insurance Code and, for the employees of the State 
Employee Group Insurance Program only, the coverage as also 
provided in Section 6.11B of this Act. The Department of 
Insurance shall enforce the requirements of this Section with 
respect to Sections 370c and 370c.1 of the Illinois Insurance 
Code; all other requirements of this Section shall be enforced 
by the Department of Central Management Services.
    Rulemaking authority to implement Public Act 95-1045, if 
any, is conditioned on the rules being adopted in accordance 
with all provisions of the Illinois Administrative Procedure 
Act and all rules and procedures of the Joint Committee on 
Administrative Rules; any purported rule not so adopted, for 
whatever reason, is unauthorized. 
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. 
1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768, 
eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 
102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 
1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84, 
eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24; 
103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff. 
8-11-23; revised 8-29-23.)
 
    (5 ILCS 375/6.11B)
    Sec. 6.11B. Infertility coverage.
    (a) Beginning on January 1, 2024, the State Employees 
Group Insurance Program shall provide coverage for the 
diagnosis and treatment of infertility, including, but not 
limited to, in vitro fertilization, uterine embryo lavage, 
embryo transfer, artificial insemination, gamete 
intrafallopian tube transfer, zygote intrafallopian tube 
transfer, and low tubal ovum transfer. The coverage required 
shall include procedures necessary to screen or diagnose a 
fertilized egg before implantation, including, but not limited 
to, preimplantation genetic diagnosis, preimplantation genetic 
screening, and prenatal genetic diagnosis.
    (b) Beginning on January 1, 2024, coverage under this 
Section for procedures for in vitro fertilization, gamete 
intrafallopian tube transfer, or zygote intrafallopian tube 
transfer shall be required only if the procedures:
        (1) are considered medically appropriate based on 
    clinical guidelines or standards developed by the American 
    Society for Reproductive Medicine, the American College of 
    Obstetricians and Gynecologists, or the Society for 
    Assisted Reproductive Technology; and
        (2) are performed at medical facilities or clinics 
    that conform to the American College of Obstetricians and 
    Gynecologists guidelines for in vitro fertilization or the 
    American Society for Reproductive Medicine minimum 
    standards for practices offering assisted reproductive 
    technologies. 
    (c) As used in this Section, "infertility" means a 
disease, condition, or status characterized by: 
        (1) a failure to establish a pregnancy or to carry a 
    pregnancy to live birth after 12 months of regular, 
    unprotected sexual intercourse if the woman is 35 years of 
    age or younger, or after 6 months of regular, unprotected 
    sexual intercourse if the woman is over 35 years of age; 
    conceiving but having a miscarriage does not restart the 
    12-month or 6-month term for determining infertility;
        (2) a person's inability to reproduce either as a 
    single individual or with a partner without medical 
    intervention; or
        (3) a licensed physician's findings based on a 
    patient's medical, sexual, and reproductive history, age, 
    physical findings, or diagnostic testing. 
    (d) The State Employees Group Insurance Program may not 
impose any exclusions, limitations, or other restrictions on 
coverage of fertility medications that are different from 
those imposed on any other prescription medications, nor may 
it impose any exclusions, limitations, or other restrictions 
on coverage of any fertility services based on a covered 
individual's participation in fertility services provided by 
or to a third party, nor may it impose deductibles, 
copayments, coinsurance, benefit maximums, waiting periods, or 
any other limitations on coverage for the diagnosis of 
infertility, treatment for infertility, and standard fertility 
preservation services, except as provided in this Section, 
that are different from those imposed upon benefits for 
services not related to infertility. 
    (e) This Section applies only to coverage provided on or 
after January 1, 2024 and before July 1, 2026.
    (f) This Section is repealed on July 1, 2026. 
(Source: P.A. 103-8, eff. 1-1-24.)
 
    Section 10. The Counties Code is amended by changing 
Section 5-1069.3 as follows:
 
    (55 ILCS 5/5-1069.3)
    Sec. 5-1069.3. Required health benefits. If a county, 
including a home rule county, is a self-insurer for purposes 
of providing health insurance coverage for its employees, the 
coverage shall include coverage for the post-mastectomy care 
benefits required to be covered by a policy of accident and 
health insurance under Section 356t and the coverage required 
under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 
356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 
356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 
356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, 
356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 
356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and 
356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, 356z.70, and 
356z.71 of the Illinois Insurance Code. The coverage shall 
comply with Sections 155.22a, 355b, 356z.19, and 370c of the 
Illinois Insurance Code. The Department of Insurance shall 
enforce the requirements of this Section. The requirement that 
health benefits be covered as provided in this Section is an 
exclusive power and function of the State and is a denial and 
limitation under Article VII, Section 6, subsection (h) of the 
Illinois Constitution. A home rule county to which this 
Section applies must comply with every provision of this 
Section. 
    Rulemaking authority to implement Public Act 95-1045, if 
any, is conditioned on the rules being adopted in accordance 
with all provisions of the Illinois Administrative Procedure 
Act and all rules and procedures of the Joint Committee on 
Administrative Rules; any purported rule not so adopted, for 
whatever reason, is unauthorized. 
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 
1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, 
eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 
102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 
1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, 
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 
103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised 
8-29-23.)
 
    Section 15. The Illinois Municipal Code is amended by 
changing Section 10-4-2.3 as follows:
 
    (65 ILCS 5/10-4-2.3)
    Sec. 10-4-2.3. Required health benefits. If a 
municipality, including a home rule municipality, is a 
self-insurer for purposes of providing health insurance 
coverage for its employees, the coverage shall include 
coverage for the post-mastectomy care benefits required to be 
covered by a policy of accident and health insurance under 
Section 356t and the coverage required under Sections 356g, 
356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x, 356z.4, 
356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 
356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, 
356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41, 
356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54, 
356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and 356z.62, 
356z.64, 356z.67, 356z.68, 356z.70, and 356z.71 of the 
Illinois Insurance Code. The coverage shall comply with 
Sections 155.22a, 355b, 356z.19, and 370c of the Illinois 
Insurance Code. The Department of Insurance shall enforce the 
requirements of this Section. The requirement that health 
benefits be covered as provided in this is an exclusive power 
and function of the State and is a denial and limitation under 
Article VII, Section 6, subsection (h) of the Illinois 
Constitution. A home rule municipality to which this Section 
applies must comply with every provision of this Section. 
    Rulemaking authority to implement Public Act 95-1045, if 
any, is conditioned on the rules being adopted in accordance 
with all provisions of the Illinois Administrative Procedure 
Act and all rules and procedures of the Joint Committee on 
Administrative Rules; any purported rule not so adopted, for 
whatever reason, is unauthorized. 
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 
1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, 
eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 
102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 
1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, 
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 
103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised 
8-29-23.)
 
    Section 20. The School Code is amended by changing Section 
10-22.3f as follows:
 
    (105 ILCS 5/10-22.3f)
    Sec. 10-22.3f. Required health benefits. Insurance 
protection and benefits for employees shall provide the 
post-mastectomy care benefits required to be covered by a 
policy of accident and health insurance under Section 356t and 
the coverage required under Sections 356g, 356g.5, 356g.5-1, 
356m, 356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 
356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 
356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, 
356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51, 
356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and 
356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, 356z.70, and 
356z.71 of the Illinois Insurance Code. Insurance policies 
shall comply with Section 356z.19 of the Illinois Insurance 
Code. The coverage shall comply with Sections 155.22a, 355b, 
and 370c of the Illinois Insurance Code. The Department of 
Insurance shall enforce the requirements of this Section. 
    Rulemaking authority to implement Public Act 95-1045, if 
any, is conditioned on the rules being adopted in accordance 
with all provisions of the Illinois Administrative Procedure 
Act and all rules and procedures of the Joint Committee on 
Administrative Rules; any purported rule not so adopted, for 
whatever reason, is unauthorized. 
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. 
1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804, 
eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 
102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 
1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, 
eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 
103-551, eff. 8-11-23; revised 8-29-23.)
 
    Section 25. The Illinois Insurance Code is amended by 
changing Sections 356m and 356z.32 and by adding Section 
356z.71 as follows:
 
    (215 ILCS 5/356m)  (from Ch. 73, par. 968m)
    Sec. 356m. Infertility coverage. 
    (a) No group policy of accident and health insurance 
providing coverage for more than 25 employees that provides 
pregnancy-related pregnancy related benefits may be issued, 
amended, delivered, or renewed in this State after January 1, 
2016 and through December 31, 2025 the effective date of this 
amendatory Act of the 99th General Assembly unless the policy 
contains coverage for the diagnosis and treatment of 
infertility including, but not limited to, in vitro 
fertilization, uterine embryo lavage, embryo transfer, 
artificial insemination, gamete intrafallopian tube transfer, 
zygote intrafallopian tube transfer, and low tubal ovum 
transfer.
    (a-5) No group policy of accident and health insurance 
that provides pregnancy-related benefits may be issued, 
amended, delivered, or renewed in this State on or after 
January 1, 2026 unless the policy contains coverage for the 
diagnosis and treatment of infertility, including, but not 
limited to, in vitro fertilization, uterine embryo lavage, 
embryo transfer, artificial insemination, gamete 
intrafallopian tube transfer, zygote intrafallopian tube 
transfer, surgical sperm extraction procedures, and low tubal 
ovum transfer. The coverage required shall include procedures 
necessary to screen or diagnose a fertilized egg before 
implantation, including, but not limited to, preimplantation 
genetic testing for aneuploidy, preimplantation genetic 
testing for chromosome structural rearrangements, and 
preimplantation genetic testing for monogenic or single gene 
disorders. Coverage under this subsection for the diagnosis 
and treatment of infertility shall be required only if the 
procedures:
        (1) are considered medically appropriate by the 
    patient's medical provider based on clinical guidelines or 
    standards developed by the American Society for 
    Reproductive Medicine, the American College of 
    Obstetricians and Gynecologists, or the Society for 
    Assisted Reproductive Technology; and
        (2) are performed at medical facilities or clinics 
    that are members in good standing of the Society for 
    Assisted Reproductive Technology. 
    (b) The coverage required under subsection (a) for 
procedures for in vitro fertilization, gamete intrafallopian 
tube transfer, or zygote intrafallopian tube transfer shall be 
required only if is subject to the following conditions:
        (1) Coverage for procedures for in vitro 
    fertilization, gamete intrafallopian tube transfer, or 
    zygote intrafallopian tube transfer shall be required only 
    if:
        (1) (A) the covered individual has been unable to 
    attain a viable pregnancy, maintain a viable pregnancy, or 
    sustain a successful pregnancy through reasonable, less 
    costly medically appropriate infertility treatments for 
    which coverage is available under the policy, plan, or 
    contract;
        (2) (B) the covered individual has not undergone 4 
    completed oocyte retrievals, except that if a live birth 
    follows a completed oocyte retrieval, then 2 more 
    completed oocyte retrievals shall be covered; and
        (3) (C) the procedures are performed at medical 
    facilities that conform to the American College of 
    Obstetric and Gynecology guidelines for in vitro 
    fertilization clinics or to the American Fertility Society 
    minimal standards for programs of in vitro fertilization.
        (2) The procedures required to be covered under this 
    Section are not required to be contained in any policy or 
    plan issued to or by a religious institution or 
    organization or to or by an entity sponsored by a 
    religious institution or organization that finds the 
    procedures required to be covered under this Section to 
    violate its religious and moral teachings and beliefs.
    (c) As used in this Section, "infertility" means a 
disease, condition, or status characterized by:
        (1) a failure to establish a pregnancy or to carry a 
    pregnancy to live birth after 12 months of regular, 
    unprotected sexual intercourse if the woman is 35 years of 
    age or younger, or after 6 months of regular, unprotected 
    sexual intercourse if the woman is over 35 years of age; 
    conceiving but having a miscarriage does not restart the 
    12-month or 6-month term for determining infertility;
        (2) a person's inability to reproduce either as a 
    single individual or with a partner without medical 
    intervention; or
        (3) a licensed physician's findings based on a 
    patient's medical, sexual, and reproductive history, age, 
    physical findings, or diagnostic testing. 
    (d) A policy, contract, or certificate may not impose any 
exclusions, limitations, or other restrictions on coverage of 
fertility medications that are different from those imposed on 
any other prescription medications, nor may it impose any 
exclusions, limitations, or other restrictions on coverage of 
any fertility services based on a covered individual's 
participation in fertility services provided by or to a third 
party, nor may it impose deductibles, copayments, coinsurance, 
benefit maximums, waiting periods, or any other limitations on 
coverage for the diagnosis of infertility, treatment for 
infertility, and standard fertility preservation services, 
except as provided in this Section, that are different from 
those imposed upon benefits for services not related to 
infertility. 
    (e) The procedures required to be covered under this 
Section are not required to be contained in any policy or plan 
issued to or by a religious institution or organization or to 
or by an entity sponsored by a religious institution or 
organization that finds the procedures required to be covered 
under this Section to violate its religious and moral 
teachings and beliefs. 
(Source: P.A. 102-170, eff. 1-1-22.)
 
    (215 ILCS 5/356z.71 new)
    Sec. 356z.71. Coverage for annual menopause health visit. 
A group or individual policy of accident and health insurance 
providing coverage for more than 25 employees that is amended, 
delivered, issued, or renewed on or after January 1, 2026 
shall provide, for individuals 45 years of age and older, 
coverage for an annual menopause health visit. A policy 
subject to this Section shall not impose a deductible, 
coinsurance, copayment, or any other cost-sharing requirement 
on the coverage provided; except that this Section does not 
apply to this coverage to the extent such coverage would 
disqualify a high-deductible health plan from eligibility for 
a health savings account pursuant to Section 223 of the 
Internal Revenue Code.
 
    Section 30. The Health Maintenance Organization Act is 
amended by changing Section 5-3 as follows:
 
    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
    Sec. 5-3. Insurance Code provisions. 
    (a) Health Maintenance Organizations shall be subject to 
the provisions of Sections 133, 134, 136, 137, 139, 140, 
141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 
154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49, 
355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356v, 
356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 
356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 
356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21, 356z.22, 
356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29, 356z.30, 
356z.30a, 356z.31, 356z.32, 356z.33, 356z.34, 356z.35, 
356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41, 356z.44, 
356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50, 356z.51, 
356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58, 356z.59, 
356z.60, 356z.61, 356z.62, 356z.64, 356z.65, 356z.67, 356z.68, 
356z.71, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b, 
368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 
408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of 
subsection (2) of Section 367, and Articles IIA, VIII 1/2, 
XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the 
Illinois Insurance Code.
    (b) For purposes of the Illinois Insurance Code, except 
for Sections 444 and 444.1 and Articles XIII and XIII 1/2, 
Health Maintenance Organizations in the following categories 
are deemed to be "domestic companies":
        (1) a corporation authorized under the Dental Service 
    Plan Act or the Voluntary Health Services Plans Act;
        (2) a corporation organized under the laws of this 
    State; or
        (3) a corporation organized under the laws of another 
    state, 30% or more of the enrollees of which are residents 
    of this State, except a corporation subject to 
    substantially the same requirements in its state of 
    organization as is a "domestic company" under Article VIII 
    1/2 of the Illinois Insurance Code.
    (c) In considering the merger, consolidation, or other 
acquisition of control of a Health Maintenance Organization 
pursuant to Article VIII 1/2 of the Illinois Insurance Code,
        (1) the Director shall give primary consideration to 
    the continuation of benefits to enrollees and the 
    financial conditions of the acquired Health Maintenance 
    Organization after the merger, consolidation, or other 
    acquisition of control takes effect;
        (2)(i) the criteria specified in subsection (1)(b) of 
    Section 131.8 of the Illinois Insurance Code shall not 
    apply and (ii) the Director, in making his determination 
    with respect to the merger, consolidation, or other 
    acquisition of control, need not take into account the 
    effect on competition of the merger, consolidation, or 
    other acquisition of control;
        (3) the Director shall have the power to require the 
    following information:
            (A) certification by an independent actuary of the 
        adequacy of the reserves of the Health Maintenance 
        Organization sought to be acquired;
            (B) pro forma financial statements reflecting the 
        combined balance sheets of the acquiring company and 
        the Health Maintenance Organization sought to be 
        acquired as of the end of the preceding year and as of 
        a date 90 days prior to the acquisition, as well as pro 
        forma financial statements reflecting projected 
        combined operation for a period of 2 years;
            (C) a pro forma business plan detailing an 
        acquiring party's plans with respect to the operation 
        of the Health Maintenance Organization sought to be 
        acquired for a period of not less than 3 years; and
            (D) such other information as the Director shall 
        require.
    (d) The provisions of Article VIII 1/2 of the Illinois 
Insurance Code and this Section 5-3 shall apply to the sale by 
any health maintenance organization of greater than 10% of its 
enrollee population (including, without limitation, the health 
maintenance organization's right, title, and interest in and 
to its health care certificates).
    (e) In considering any management contract or service 
agreement subject to Section 141.1 of the Illinois Insurance 
Code, the Director (i) shall, in addition to the criteria 
specified in Section 141.2 of the Illinois Insurance Code, 
take into account the effect of the management contract or 
service agreement on the continuation of benefits to enrollees 
and the financial condition of the health maintenance 
organization to be managed or serviced, and (ii) need not take 
into account the effect of the management contract or service 
agreement on competition.
    (f) Except for small employer groups as defined in the 
Small Employer Rating, Renewability and Portability Health 
Insurance Act and except for medicare supplement policies as 
defined in Section 363 of the Illinois Insurance Code, a 
Health Maintenance Organization may by contract agree with a 
group or other enrollment unit to effect refunds or charge 
additional premiums under the following terms and conditions:
        (i) the amount of, and other terms and conditions with 
    respect to, the refund or additional premium are set forth 
    in the group or enrollment unit contract agreed in advance 
    of the period for which a refund is to be paid or 
    additional premium is to be charged (which period shall 
    not be less than one year); and
        (ii) the amount of the refund or additional premium 
    shall not exceed 20% of the Health Maintenance 
    Organization's profitable or unprofitable experience with 
    respect to the group or other enrollment unit for the 
    period (and, for purposes of a refund or additional 
    premium, the profitable or unprofitable experience shall 
    be calculated taking into account a pro rata share of the 
    Health Maintenance Organization's administrative and 
    marketing expenses, but shall not include any refund to be 
    made or additional premium to be paid pursuant to this 
    subsection (f)). The Health Maintenance Organization and 
    the group or enrollment unit may agree that the profitable 
    or unprofitable experience may be calculated taking into 
    account the refund period and the immediately preceding 2 
    plan years.
    The Health Maintenance Organization shall include a 
statement in the evidence of coverage issued to each enrollee 
describing the possibility of a refund or additional premium, 
and upon request of any group or enrollment unit, provide to 
the group or enrollment unit a description of the method used 
to calculate (1) the Health Maintenance Organization's 
profitable experience with respect to the group or enrollment 
unit and the resulting refund to the group or enrollment unit 
or (2) the Health Maintenance Organization's unprofitable 
experience with respect to the group or enrollment unit and 
the resulting additional premium to be paid by the group or 
enrollment unit.
    In no event shall the Illinois Health Maintenance 
Organization Guaranty Association be liable to pay any 
contractual obligation of an insolvent organization to pay any 
refund authorized under this Section.
    (g) Rulemaking authority to implement Public Act 95-1045, 
if any, is conditioned on the rules being adopted in 
accordance with all provisions of the Illinois Administrative 
Procedure Act and all rules and procedures of the Joint 
Committee on Administrative Rules; any purported rule not so 
adopted, for whatever reason, is unauthorized. 
(Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21; 
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 
1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, 
eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 
102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 
1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, 
eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 
103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff. 
6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, 
eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.)
 
    Section 35. The Limited Health Service Organization Act is 
amended by changing Section 4003 as follows:
 
    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
    Sec. 4003. Illinois Insurance Code provisions. Limited 
health service organizations shall be subject to the 
provisions of Sections 133, 134, 136, 137, 139, 140, 141.1, 
141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, 
154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 355.2, 
355.3, 355b, 356m, 356q, 356v, 356z.4, 356z.4a, 356z.10, 
356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 
356z.32, 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 
356z.54, 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 
356z.71, 364.3, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, 
409, 412, 444, and 444.1 and Articles IIA, VIII 1/2, XII, XII 
1/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois Insurance 
Code. Nothing in this Section shall require a limited health 
care plan to cover any service that is not a limited health 
service. For purposes of the Illinois Insurance Code, except 
for Sections 444 and 444.1 and Articles XIII and XIII 1/2, 
limited health service organizations in the following 
categories are deemed to be domestic companies:
        (1) a corporation under the laws of this State; or
        (2) a corporation organized under the laws of another 
    state, 30% or more of the enrollees of which are residents 
    of this State, except a corporation subject to 
    substantially the same requirements in its state of 
    organization as is a domestic company under Article VIII 
    1/2 of the Illinois Insurance Code.
(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 
102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff. 
1-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816, 
eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 
102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 
1-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, 
eff. 1-1-24; revised 8-29-23.)
 
    Section 40. The Voluntary Health Services Plans Act is 
amended by changing Section 10 as follows:
 
    (215 ILCS 165/10)  (from Ch. 32, par. 604)
    Sec. 10. Application of Insurance Code provisions. Health 
services plan corporations and all persons interested therein 
or dealing therewith shall be subject to the provisions of 
Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140, 
143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 
356g, 356g.5, 356g.5-1, 356m, 356q, 356r, 356t, 356u, 356v, 
356w, 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 
356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 
356z.13, 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 
356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 
356z.32a, 356z.33, 356z.40, 356z.41, 356z.46, 356z.47, 
356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 
356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.71, 364.01, 
364.3, 367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, 
and 412, and paragraphs (7) and (15) of Section 367 of the 
Illinois Insurance Code.
    Rulemaking authority to implement Public Act 95-1045, if 
any, is conditioned on the rules being adopted in accordance 
with all provisions of the Illinois Administrative Procedure 
Act and all rules and procedures of the Joint Committee on 
Administrative Rules; any purported rule not so adopted, for 
whatever reason, is unauthorized. 
(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 
102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 
10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804, 
eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 
102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff. 
1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, 
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 
103-551, eff. 8-11-23; revised 8-29-23.)
 
    Section 99. Effective date. This Act takes effect upon 
becoming law.

Effective Date:  8/2/2024