SB0773sam001 103RD GENERAL ASSEMBLY

Sen. Cristina Castro

Filed: 4/9/2024

 

 


 

 


 
10300SB0773sam001LRB103 03229 RPS 72054 a

1
AMENDMENT TO SENATE BILL 773

2    AMENDMENT NO. ______. Amend Senate Bill 773 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The State Employees Group Insurance Act of
51971 is amended by changing Sections 6.11 and 6.11B as
6follows:
 
7    (5 ILCS 375/6.11)
8    Sec. 6.11. Required health benefits; Illinois Insurance
9Code requirements. The program of health benefits shall
10provide the post-mastectomy care benefits required to be
11covered by a policy of accident and health insurance under
12Section 356t of the Illinois Insurance Code. The program of
13health benefits shall provide the coverage required under
14Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
15356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
16356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,

 

 

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1356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
2356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
3356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, 356z.60,
4and 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, 356z.70,
5and 356z.71 of the Illinois Insurance Code. The program of
6health benefits must comply with Sections 155.22a, 155.37,
7355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of the
8Illinois Insurance Code. The program of health benefits shall
9provide the coverage required under Section 356m of the
10Illinois Insurance Code and, for the employees of the State
11Employee Group Insurance Program only, the coverage as also
12provided in Section 6.11B of this Act. The Department of
13Insurance shall enforce the requirements of this Section with
14respect to Sections 370c and 370c.1 of the Illinois Insurance
15Code; all other requirements of this Section shall be enforced
16by the Department of Central Management Services.
17    Rulemaking authority to implement Public Act 95-1045, if
18any, is conditioned on the rules being adopted in accordance
19with all provisions of the Illinois Administrative Procedure
20Act and all rules and procedures of the Joint Committee on
21Administrative Rules; any purported rule not so adopted, for
22whatever reason, is unauthorized.
23(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
24102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
251-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768,
26eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;

 

 

10300SB0773sam001- 3 -LRB103 03229 RPS 72054 a

1102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
21-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84,
3eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24;
4103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff.
58-11-23; revised 8-29-23.)
 
6    (5 ILCS 375/6.11B)
7    Sec. 6.11B. Infertility coverage.
8    (a) Beginning on January 1, 2024, the State Employees
9Group Insurance Program shall provide coverage for the
10diagnosis and treatment of infertility, including, but not
11limited to, in vitro fertilization, uterine embryo lavage,
12embryo transfer, artificial insemination, gamete
13intrafallopian tube transfer, zygote intrafallopian tube
14transfer, and low tubal ovum transfer. The coverage required
15shall include procedures necessary to screen or diagnose a
16fertilized egg before implantation, including, but not limited
17to, preimplantation genetic diagnosis, preimplantation genetic
18screening, and prenatal genetic diagnosis.
19    (b) Beginning on January 1, 2024, coverage under this
20Section for procedures for in vitro fertilization, gamete
21intrafallopian tube transfer, or zygote intrafallopian tube
22transfer shall be required only if the procedures:
23        (1) are considered medically appropriate based on
24    clinical guidelines or standards developed by the American
25    Society for Reproductive Medicine, the American College of

 

 

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1    Obstetricians and Gynecologists, or the Society for
2    Assisted Reproductive Technology; and
3        (2) are performed at medical facilities or clinics
4    that conform to the American College of Obstetricians and
5    Gynecologists guidelines for in vitro fertilization or the
6    American Society for Reproductive Medicine minimum
7    standards for practices offering assisted reproductive
8    technologies.
9    (c) As used in this Section, "infertility" means a
10disease, condition, or status characterized by:
11        (1) a failure to establish a pregnancy or to carry a
12    pregnancy to live birth after 12 months of regular,
13    unprotected sexual intercourse if the woman is 35 years of
14    age or younger, or after 6 months of regular, unprotected
15    sexual intercourse if the woman is over 35 years of age;
16    conceiving but having a miscarriage does not restart the
17    12-month or 6-month term for determining infertility;
18        (2) a person's inability to reproduce either as a
19    single individual or with a partner without medical
20    intervention; or
21        (3) a licensed physician's findings based on a
22    patient's medical, sexual, and reproductive history, age,
23    physical findings, or diagnostic testing.
24    (d) The State Employees Group Insurance Program may not
25impose any exclusions, limitations, or other restrictions on
26coverage of fertility medications that are different from

 

 

10300SB0773sam001- 5 -LRB103 03229 RPS 72054 a

1those imposed on any other prescription medications, nor may
2it impose any exclusions, limitations, or other restrictions
3on coverage of any fertility services based on a covered
4individual's participation in fertility services provided by
5or to a third party, nor may it impose deductibles,
6copayments, coinsurance, benefit maximums, waiting periods, or
7any other limitations on coverage for the diagnosis of
8infertility, treatment for infertility, and standard fertility
9preservation services, except as provided in this Section,
10that are different from those imposed upon benefits for
11services not related to infertility.
12    (e) This Section applies only to coverage provided on or
13after January 1, 2024 and before July 1, 2026.
14    (f) This Section is repealed on July 1, 2026.
15(Source: P.A. 103-8, eff. 1-1-24.)
 
16    Section 10. The Counties Code is amended by changing
17Section 5-1069.3 as follows:
 
18    (55 ILCS 5/5-1069.3)
19    Sec. 5-1069.3. Required health benefits. If a county,
20including a home rule county, is a self-insurer for purposes
21of providing health insurance coverage for its employees, the
22coverage shall include coverage for the post-mastectomy care
23benefits required to be covered by a policy of accident and
24health insurance under Section 356t and the coverage required

 

 

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1under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w,
2356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
3356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25,
4356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36,
5356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
6356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and
7356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, 356z.70, and
8356z.71 of the Illinois Insurance Code. The coverage shall
9comply with Sections 155.22a, 355b, 356z.19, and 370c of the
10Illinois Insurance Code. The Department of Insurance shall
11enforce the requirements of this Section. The requirement that
12health benefits be covered as provided in this Section is an
13exclusive power and function of the State and is a denial and
14limitation under Article VII, Section 6, subsection (h) of the
15Illinois Constitution. A home rule county to which this
16Section applies must comply with every provision of this
17Section.
18    Rulemaking authority to implement Public Act 95-1045, if
19any, is conditioned on the rules being adopted in accordance
20with all provisions of the Illinois Administrative Procedure
21Act and all rules and procedures of the Joint Committee on
22Administrative Rules; any purported rule not so adopted, for
23whatever reason, is unauthorized.
24(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
25102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
261-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,

 

 

10300SB0773sam001- 7 -LRB103 03229 RPS 72054 a

1eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
2102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
31-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
4eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
5103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
68-29-23.)
 
7    Section 15. The Illinois Municipal Code is amended by
8changing Section 10-4-2.3 as follows:
 
9    (65 ILCS 5/10-4-2.3)
10    Sec. 10-4-2.3. Required health benefits. If a
11municipality, including a home rule municipality, is a
12self-insurer for purposes of providing health insurance
13coverage for its employees, the coverage shall include
14coverage for the post-mastectomy care benefits required to be
15covered by a policy of accident and health insurance under
16Section 356t and the coverage required under Sections 356g,
17356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x, 356z.4,
18356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
19356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
20356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
21356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
22356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and 356z.62,
23356z.64, 356z.67, 356z.68, 356z.70, and 356z.71 of the
24Illinois Insurance Code. The coverage shall comply with

 

 

10300SB0773sam001- 8 -LRB103 03229 RPS 72054 a

1Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
2Insurance Code. The Department of Insurance shall enforce the
3requirements of this Section. The requirement that health
4benefits be covered as provided in this is an exclusive power
5and function of the State and is a denial and limitation under
6Article VII, Section 6, subsection (h) of the Illinois
7Constitution. A home rule municipality to which this Section
8applies must comply with every provision of this Section.
9    Rulemaking authority to implement Public Act 95-1045, if
10any, is conditioned on the rules being adopted in accordance
11with all provisions of the Illinois Administrative Procedure
12Act and all rules and procedures of the Joint Committee on
13Administrative Rules; any purported rule not so adopted, for
14whatever reason, is unauthorized.
15(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
16102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
171-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
18eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
19102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
201-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
21eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
22103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
238-29-23.)
 
24    Section 20. The School Code is amended by changing Section
2510-22.3f as follows:
 

 

 

10300SB0773sam001- 9 -LRB103 03229 RPS 72054 a

1    (105 ILCS 5/10-22.3f)
2    Sec. 10-22.3f. Required health benefits. Insurance
3protection and benefits for employees shall provide the
4post-mastectomy care benefits required to be covered by a
5policy of accident and health insurance under Section 356t and
6the coverage required under Sections 356g, 356g.5, 356g.5-1,
7356m, 356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8,
8356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
9356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
10356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
11356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and
12356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, 356z.70, and
13356z.71 of the Illinois Insurance Code. Insurance policies
14shall comply with Section 356z.19 of the Illinois Insurance
15Code. The coverage shall comply with Sections 155.22a, 355b,
16and 370c of the Illinois Insurance Code. The Department of
17Insurance shall enforce the requirements of this Section.
18    Rulemaking authority to implement Public Act 95-1045, if
19any, is conditioned on the rules being adopted in accordance
20with all provisions of the Illinois Administrative Procedure
21Act and all rules and procedures of the Joint Committee on
22Administrative Rules; any purported rule not so adopted, for
23whatever reason, is unauthorized.
24(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
25102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.

 

 

10300SB0773sam001- 10 -LRB103 03229 RPS 72054 a

11-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,
2eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
3102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.
41-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,
5eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;
6103-551, eff. 8-11-23; revised 8-29-23.)
 
7    Section 25. The Illinois Insurance Code is amended by
8changing Sections 356m and 356z.32 and by adding Section
9356z.71 as follows:
 
10    (215 ILCS 5/356m)  (from Ch. 73, par. 968m)
11    Sec. 356m. Infertility coverage.
12    (a) No group policy of accident and health insurance
13providing coverage for more than 25 employees that provides
14pregnancy-related pregnancy related benefits may be issued,
15amended, delivered, or renewed in this State after January 1,
162016 and through December 31, 2025 the effective date of this
17amendatory Act of the 99th General Assembly unless the policy
18contains coverage for the diagnosis and treatment of
19infertility including, but not limited to, in vitro
20fertilization, uterine embryo lavage, embryo transfer,
21artificial insemination, gamete intrafallopian tube transfer,
22zygote intrafallopian tube transfer, and low tubal ovum
23transfer.
24    (a-5) No group policy of accident and health insurance

 

 

10300SB0773sam001- 11 -LRB103 03229 RPS 72054 a

1that provides pregnancy-related benefits may be issued,
2amended, delivered, or renewed in this State on or after
3January 1, 2026 unless the policy contains coverage for the
4diagnosis and treatment of infertility, including, but not
5limited to, in vitro fertilization, uterine embryo lavage,
6embryo transfer, artificial insemination, gamete
7intrafallopian tube transfer, zygote intrafallopian tube
8transfer, surgical sperm extraction procedures, and low tubal
9ovum transfer. The coverage required shall include procedures
10necessary to screen or diagnose a fertilized egg before
11implantation, including, but not limited to, preimplantation
12genetic testing for aneuploidy, preimplantation genetic
13testing for chromosome structural rearrangements, and
14preimplantation genetic testing for monogenic or single gene
15disorders. Coverage under this subsection for the diagnosis
16and treatment of infertility shall be required only if the
17procedures:
18        (1) are considered medically appropriate by the
19    patient's medical provider based on clinical guidelines or
20    standards developed by the American Society for
21    Reproductive Medicine, the American College of
22    Obstetricians and Gynecologists, or the Society for
23    Assisted Reproductive Technology; and
24        (2) are performed at medical facilities or clinics
25    that are members in good standing of the Society for
26    Assisted Reproductive Technology.

 

 

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1    (b) The coverage required under subsection (a) for
2procedures for in vitro fertilization, gamete intrafallopian
3tube transfer, or zygote intrafallopian tube transfer shall be
4required only if is subject to the following conditions:
5        (1) Coverage for procedures for in vitro
6    fertilization, gamete intrafallopian tube transfer, or
7    zygote intrafallopian tube transfer shall be required only
8    if:
9        (1) (A) the covered individual has been unable to
10    attain a viable pregnancy, maintain a viable pregnancy, or
11    sustain a successful pregnancy through reasonable, less
12    costly medically appropriate infertility treatments for
13    which coverage is available under the policy, plan, or
14    contract;
15        (2) (B) the covered individual has not undergone 4
16    completed oocyte retrievals, except that if a live birth
17    follows a completed oocyte retrieval, then 2 more
18    completed oocyte retrievals shall be covered; and
19        (3) (C) the procedures are performed at medical
20    facilities that conform to the American College of
21    Obstetric and Gynecology guidelines for in vitro
22    fertilization clinics or to the American Fertility Society
23    minimal standards for programs of in vitro fertilization.
24        (2) The procedures required to be covered under this
25    Section are not required to be contained in any policy or
26    plan issued to or by a religious institution or

 

 

10300SB0773sam001- 13 -LRB103 03229 RPS 72054 a

1    organization or to or by an entity sponsored by a
2    religious institution or organization that finds the
3    procedures required to be covered under this Section to
4    violate its religious and moral teachings and beliefs.
5    (c) As used in this Section, "infertility" means a
6disease, condition, or status characterized by:
7        (1) a failure to establish a pregnancy or to carry a
8    pregnancy to live birth after 12 months of regular,
9    unprotected sexual intercourse if the woman is 35 years of
10    age or younger, or after 6 months of regular, unprotected
11    sexual intercourse if the woman is over 35 years of age;
12    conceiving but having a miscarriage does not restart the
13    12-month or 6-month term for determining infertility;
14        (2) a person's inability to reproduce either as a
15    single individual or with a partner without medical
16    intervention; or
17        (3) a licensed physician's findings based on a
18    patient's medical, sexual, and reproductive history, age,
19    physical findings, or diagnostic testing.
20    (d) A policy, contract, or certificate may not impose any
21exclusions, limitations, or other restrictions on coverage of
22fertility medications that are different from those imposed on
23any other prescription medications, nor may it impose any
24exclusions, limitations, or other restrictions on coverage of
25any fertility services based on a covered individual's
26participation in fertility services provided by or to a third

 

 

10300SB0773sam001- 14 -LRB103 03229 RPS 72054 a

1party, nor may it impose deductibles, copayments, coinsurance,
2benefit maximums, waiting periods, or any other limitations on
3coverage for the diagnosis of infertility, treatment for
4infertility, and standard fertility preservation services,
5except as provided in this Section, that are different from
6those imposed upon benefits for services not related to
7infertility.
8    (e) The procedures required to be covered under this
9Section are not required to be contained in any policy or plan
10issued to or by a religious institution or organization or to
11or by an entity sponsored by a religious institution or
12organization that finds the procedures required to be covered
13under this Section to violate its religious and moral
14teachings and beliefs.
15(Source: P.A. 102-170, eff. 1-1-22.)
 
16    (215 ILCS 5/356z.71 new)
17    Sec. 356z.71. Coverage for annual menopause health visit.
18A group or individual policy of accident and health insurance
19providing coverage for more than 25 employees that is amended,
20delivered, issued, or renewed on or after January 1, 2026
21shall provide, for individuals 45 years of age and older,
22coverage for an annual menopause health visit. A policy
23subject to this Section shall not impose a deductible,
24coinsurance, copayment, or any other cost-sharing requirement
25on the coverage provided; except that this Section does not

 

 

10300SB0773sam001- 15 -LRB103 03229 RPS 72054 a

1apply to this coverage to the extent such coverage would
2disqualify a high-deductible health plan from eligibility for
3a health savings account pursuant to Section 223 of the
4Internal Revenue Code.
 
5    Section 30. The Health Maintenance Organization Act is
6amended by changing Section 5-3 as follows:
 
7    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
8    Sec. 5-3. Insurance Code provisions.
9    (a) Health Maintenance Organizations shall be subject to
10the provisions of Sections 133, 134, 136, 137, 139, 140,
11141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
12154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49,
13355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356v,
14356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
15356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
16356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21, 356z.22,
17356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29, 356z.30,
18356z.30a, 356z.31, 356z.32, 356z.33, 356z.34, 356z.35,
19356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41, 356z.44,
20356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50, 356z.51,
21356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58, 356z.59,
22356z.60, 356z.61, 356z.62, 356z.64, 356z.65, 356z.67, 356z.68,
23356z.71, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b,
24368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A,

 

 

10300SB0773sam001- 16 -LRB103 03229 RPS 72054 a

1408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
2subsection (2) of Section 367, and Articles IIA, VIII 1/2,
3XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
4Illinois Insurance Code.
5    (b) For purposes of the Illinois Insurance Code, except
6for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
7Health Maintenance Organizations in the following categories
8are deemed to be "domestic companies":
9        (1) a corporation authorized under the Dental Service
10    Plan Act or the Voluntary Health Services Plans Act;
11        (2) a corporation organized under the laws of this
12    State; or
13        (3) a corporation organized under the laws of another
14    state, 30% or more of the enrollees of which are residents
15    of this State, except a corporation subject to
16    substantially the same requirements in its state of
17    organization as is a "domestic company" under Article VIII
18    1/2 of the Illinois Insurance Code.
19    (c) In considering the merger, consolidation, or other
20acquisition of control of a Health Maintenance Organization
21pursuant to Article VIII 1/2 of the Illinois Insurance Code,
22        (1) the Director shall give primary consideration to
23    the continuation of benefits to enrollees and the
24    financial conditions of the acquired Health Maintenance
25    Organization after the merger, consolidation, or other
26    acquisition of control takes effect;

 

 

10300SB0773sam001- 17 -LRB103 03229 RPS 72054 a

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

 

 

10300SB0773sam001- 18 -LRB103 03229 RPS 72054 a

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

 

 

10300SB0773sam001- 19 -LRB103 03229 RPS 72054 a

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

 

 

10300SB0773sam001- 20 -LRB103 03229 RPS 72054 a

1experience with respect to the group or enrollment unit and
2the resulting additional premium to be paid by the group or
3enrollment unit.
4    In no event shall the Illinois Health Maintenance
5Organization Guaranty Association be liable to pay any
6contractual obligation of an insolvent organization to pay any
7refund authorized under this Section.
8    (g) Rulemaking authority to implement Public Act 95-1045,
9if any, is conditioned on the rules being adopted in
10accordance with all provisions of the Illinois Administrative
11Procedure Act and all rules and procedures of the Joint
12Committee on Administrative Rules; any purported rule not so
13adopted, for whatever reason, is unauthorized.
14(Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
15102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
161-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
17eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
18102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
191-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
20eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
21103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
226-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
23eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.)
 
24    Section 35. The Limited Health Service Organization Act is
25amended by changing Section 4003 as follows:
 

 

 

10300SB0773sam001- 21 -LRB103 03229 RPS 72054 a

1    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
2    Sec. 4003. Illinois Insurance Code provisions. Limited
3health service organizations shall be subject to the
4provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
5141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
6154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 355.2,
7355.3, 355b, 356m, 356q, 356v, 356z.4, 356z.4a, 356z.10,
8356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30a,
9356z.32, 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53,
10356z.54, 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68,
11356z.71, 364.3, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2,
12409, 412, 444, and 444.1 and Articles IIA, VIII 1/2, XII, XII
131/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois Insurance
14Code. Nothing in this Section shall require a limited health
15care plan to cover any service that is not a limited health
16service. For purposes of the Illinois Insurance Code, except
17for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
18limited health service organizations in the following
19categories are deemed to be domestic companies:
20        (1) a corporation under the laws of this State; or
21        (2) a corporation organized under the laws of another
22    state, 30% or more of the enrollees of which are residents
23    of this State, except a corporation subject to
24    substantially the same requirements in its state of
25    organization as is a domestic company under Article VIII

 

 

10300SB0773sam001- 22 -LRB103 03229 RPS 72054 a

1    1/2 of the Illinois Insurance Code.
2(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
3102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
41-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,
5eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
6102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
71-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
8eff. 1-1-24; revised 8-29-23.)
 
9    Section 40. The Voluntary Health Services Plans Act is
10amended by changing Section 10 as follows:
 
11    (215 ILCS 165/10)  (from Ch. 32, par. 604)
12    Sec. 10. Application of Insurance Code provisions. Health
13services plan corporations and all persons interested therein
14or dealing therewith shall be subject to the provisions of
15Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
16143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
17356g, 356g.5, 356g.5-1, 356m, 356q, 356r, 356t, 356u, 356v,
18356w, 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a,
19356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
20356z.13, 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22,
21356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32,
22356z.32a, 356z.33, 356z.40, 356z.41, 356z.46, 356z.47,
23356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60,
24356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.71, 364.01,

 

 

10300SB0773sam001- 23 -LRB103 03229 RPS 72054 a

1364.3, 367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2,
2and 412, and paragraphs (7) and (15) of Section 367 of the
3Illinois Insurance Code.
4    Rulemaking authority to implement Public Act 95-1045, if
5any, is conditioned on the rules being adopted in accordance
6with all provisions of the Illinois Administrative Procedure
7Act and all rules and procedures of the Joint Committee on
8Administrative Rules; any purported rule not so adopted, for
9whatever reason, is unauthorized.
10(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
11102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
1210-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
13eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
14102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
151-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
16eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
17103-551, eff. 8-11-23; revised 8-29-23.)
 
18    Section 99. Effective date. This Act takes effect upon
19becoming law.".