Public Act 103-0618
 
SB2735 EnrolledLRB103 34765 RPS 64615 b

    AN ACT concerning regulation.
 
    Be it enacted by the People of the State of Illinois, 
represented in the General Assembly:
 
    Section 5. The Illinois Insurance Code is amended by 
adding Section 355.6 as follows:
 
    (215 ILCS 5/355.6 new)
    Sec. 355.6. Health care provider reimbursement.
    (a) In this Section, "health care provider" has the 
meaning given to the term "provider" in Section 370g.
    (b) Any group or individual policy of accident and health 
insurance or managed care plan amended, delivered, issued, or 
renewed on or after January 1, 2026 shall offer all reasonably 
available methods of payment from the insurer or managed care 
plan, or its contracted vendor, to the contracted health care 
provider, which shall include, but not be limited to, payment 
by check and electronic funds transfer. An insurer or managed 
care plan shall not mandate payment by credit card. For 
purposes of this subsection, "credit card" means a single-use 
or virtual credit card provided in an electronic, digital, 
facsimile, physical, or paper format.
    (c) If one of the available payment methods has a fee 
associated with it, the insurer or managed care plan, or its 
contracted vendor, shall, prior to initiating the first 
payment to an in-network health care provider or upon changing 
the payment methods available to a health care provider:
        (1) notify the health care provider that there may be 
    fees associated with a particular payment method and that 
    the insurer or managed care plan, or its contracted 
    vendor, shall disclose any fees beyond what the health 
    care provider would normally pay to process a payment 
    using that payment method; and
        (2) provide the health care provider with clear 
    instructions on the insurer's or managed care plan's, or 
    its contracted vendor's, website or through means other 
    than the contract offered to the health care provider as 
    to how to select each method.
    (d) If a health care provider requests a change in the 
available payment method, the insurer or managed care plan, or 
its contracted vendor, shall implement the change to the 
payment method selected by the health care provider within 30 
business days, subject to federal and State verification 
measures to prevent fraud and abuse.
    (e) An insurer or managed care plan shall not use a health 
care provider's preferred method of payment as a factor when 
deciding whether to provide credentials to a health care 
provider.
 
    Section 10. 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, 355.6, 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, 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.)

Effective Date:  1/1/2025