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Public Act 103-0700 Public Act 0700 103RD GENERAL ASSEMBLY | Public Act 103-0700 | HB5258 Enrolled | LRB103 38992 RPS 69129 b |
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| 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 356z.71 as follows: | (215 ILCS 5/356z.71 new) | Sec. 356z.71. Insurance coverage for dependent parents. | (a) A group or individual policy of accident and health | insurance issued, amended, delivered, or renewed after January | 1, 2026 that provides dependent coverage shall make that | dependent coverage available to the parent or stepparent of | the insured if the parent or stepparent meets the definition | of a qualifying relative under 26 U.S.C. 152(d) and lives or | resides within the accident and health insurance policy's | service area. | (b) This Section does not apply to specialized health care | service plans, Medicare supplement insurance, hospital-only | policies, accident-only policies, or specified disease | insurance policies that reimburse for hospital, medical, or | surgical expenses. | 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, 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 15. 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, 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.) |
Effective Date: 1/1/2025
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