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HB3248 Enrolled LRB104 08344 BAB 18395 b
1 AN ACT concerning regulation.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 Section 5. The State Employees Group Insurance Act of 1971
5 is amended by changing Section 6.11 as follows:
6 (5 ILCS 375/6.11)
7 Sec. 6.11. Required health benefits; Illinois Insurance
8 Code requirements. The program of health benefits shall
9 provide the post-mastectomy care benefits required to be
10 covered by a policy of accident and health insurance under
11 Section 356t of the Illinois Insurance Code. The program of
12 health benefits shall provide the coverage required under
13 Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10,
14 356w, 356x, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
15 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
16 356z.17, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
17 356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
18 356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59,
19 356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, and
20 356z.70, and 356z.71, 356z.74, 356z.76, 356z.77, and 356z.80
21 of the Illinois Insurance Code. The program of health benefits
22 must comply with Sections 155.22a, 155.37, 355b, 356z.19,
23 370c, and 370c.1 and Article XXXIIB of the Illinois Insurance
HB3248 Enrolled -2- LRB104 08344 BAB 18395 b
1 Code. The program of health benefits shall provide the
2 coverage required under Section 356m of the Illinois Insurance
3 Code and, for the employees of the State Employee Group
4 Insurance Program only, the coverage as also provided in
5 Section 6.11B of this Act. The Department of Insurance shall
6 enforce the requirements of this Section with respect to
7 Sections 370c and 370c.1 of the Illinois Insurance Code; all
8 other requirements of this Section shall be enforced by the
9 Department of Central Management Services.
10 Rulemaking authority to implement Public Act 95-1045, if
11 any, is conditioned on the rules being adopted in accordance
12 with all provisions of the Illinois Administrative Procedure
13 Act and all rules and procedures of the Joint Committee on
14 Administrative Rules; any purported rule not so adopted, for
15 whatever reason, is unauthorized.
16 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
17 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
18 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768,
19 eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
20 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
21 1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84,
22 eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24;
23 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff.
24 8-11-23; 103-605, eff. 7-1-24; 103-718, eff. 7-19-24; 103-751,
25 eff. 8-2-24; 103-870, eff. 1-1-25; 103-914, eff. 1-1-25;
26 103-918, eff. 1-1-25; 103-951, eff. 1-1-25; 103-1024, eff.
HB3248 Enrolled -3- LRB104 08344 BAB 18395 b
1 1-1-25; revised 11-26-24.)
2 Section 10. The Counties Code is amended by changing
3 Section 5-1069.3 as follows:
4 (55 ILCS 5/5-1069.3)
5 Sec. 5-1069.3. Required health benefits. If a county,
6 including a home rule county, is a self-insurer for purposes
7 of providing health insurance coverage for its employees, the
8 coverage shall include coverage for the post-mastectomy care
9 benefits required to be covered by a policy of accident and
10 health insurance under Section 356t and the coverage required
11 under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u,
12 356u.10, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9,
13 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
14 356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 356z.33, 356z.36,
15 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
16 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61,
17 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70, and 356z.71,
18 356z.74, 356z.77, and 356z.80 of the Illinois Insurance Code.
19 The coverage shall comply with Sections 155.22a, 355b,
20 356z.19, and 370c of the Illinois Insurance Code. The
21 Department of Insurance shall enforce the requirements of this
22 Section. The requirement that health benefits be covered as
23 provided in this Section is an exclusive power and function of
24 the State and is a denial and limitation under Article VII,
HB3248 Enrolled -4- LRB104 08344 BAB 18395 b
1 Section 6, subsection (h) of the Illinois Constitution. A home
2 rule county to which this Section applies must comply with
3 every provision of this Section.
4 Rulemaking authority to implement Public Act 95-1045, if
5 any, is conditioned on the rules being adopted in accordance
6 with all provisions of the Illinois Administrative Procedure
7 Act and all rules and procedures of the Joint Committee on
8 Administrative Rules; any purported rule not so adopted, for
9 whatever reason, is unauthorized.
10 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
11 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
12 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
13 eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
14 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
15 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
16 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
17 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff.
18 7-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-914,
19 eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25;
20 revised 11-26-24.)
21 Section 15. The Illinois Municipal Code is amended by
22 changing Section 10-4-2.3 as follows:
23 (65 ILCS 5/10-4-2.3)
24 Sec. 10-4-2.3. Required health benefits. If a
HB3248 Enrolled -5- LRB104 08344 BAB 18395 b
1 municipality, including a home rule municipality, is a
2 self-insurer for purposes of providing health insurance
3 coverage for its employees, the coverage shall include
4 coverage for the post-mastectomy care benefits required to be
5 covered by a policy of accident and health insurance under
6 Section 356t and the coverage required under Sections 356g,
7 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10, 356w, 356x,
8 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
9 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
10 356z.29, 356z.30, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
11 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
12 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64,
13 356z.67, 356z.68, and 356z.70, and 356z.71, 356z.74, 356z.77,
14 and 356z.80 of the Illinois Insurance Code. The coverage shall
15 comply with Sections 155.22a, 355b, 356z.19, and 370c of the
16 Illinois Insurance Code. The Department of Insurance shall
17 enforce the requirements of this Section. The requirement that
18 health benefits be covered as provided in this is an exclusive
19 power and function of the State and is a denial and limitation
20 under Article VII, Section 6, subsection (h) of the Illinois
21 Constitution. A home rule municipality to which this Section
22 applies must comply with every provision of this Section.
23 Rulemaking authority to implement Public Act 95-1045, if
24 any, is conditioned on the rules being adopted in accordance
25 with all provisions of the Illinois Administrative Procedure
26 Act and all rules and procedures of the Joint Committee on
HB3248 Enrolled -6- LRB104 08344 BAB 18395 b
1 Administrative Rules; any purported rule not so adopted, for
2 whatever reason, is unauthorized.
3 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
4 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
5 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
6 eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
7 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
8 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
9 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
10 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff.
11 7-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-914,
12 eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25;
13 revised 11-26-24.)
14 Section 20. The School Code is amended by changing Section
15 10-22.3f as follows:
16 (105 ILCS 5/10-22.3f)
17 Sec. 10-22.3f. Required health benefits. Insurance
18 protection and benefits for employees shall provide the
19 post-mastectomy care benefits required to be covered by a
20 policy of accident and health insurance under Section 356t and
21 the coverage required under Sections 356g, 356g.5, 356g.5-1,
22 356m, 356q, 356u, 356u.10, 356w, 356x, 356z.4, 356z.4a,
23 356z.6, 356z.8, 356z.9, 356z.11, 356z.12, 356z.13, 356z.14,
24 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
HB3248 Enrolled -7- LRB104 08344 BAB 18395 b
1 356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
2 356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60,
3 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70, and
4 356z.71, 356z.74, 356z.77, and 356z.80 of the Illinois
5 Insurance Code. Insurance policies shall comply with Section
6 356z.19 of the Illinois Insurance Code. The coverage shall
7 comply with Sections 155.22a, 355b, and 370c of the Illinois
8 Insurance Code. The Department of Insurance shall enforce the
9 requirements of this Section.
10 Rulemaking authority to implement Public Act 95-1045, if
11 any, is conditioned on the rules being adopted in accordance
12 with all provisions of the Illinois Administrative Procedure
13 Act and all rules and procedures of the Joint Committee on
14 Administrative Rules; any purported rule not so adopted, for
15 whatever reason, is unauthorized.
16 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
17 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
18 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,
19 eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
20 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.
21 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,
22 eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;
23 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718, eff.
24 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25; 103-918,
25 eff. 1-1-25; 103-1024, eff. 1-1-25; revised 11-26-24.)
HB3248 Enrolled -8- LRB104 08344 BAB 18395 b
1 Section 25. The Illinois Insurance Code is amended by
2 adding Section 356z.80 as follows:
3 (215 ILCS 5/356z.80 new)
4 Sec. 356z.80. Laser hair removal. Any group or individual
5 policy of accident or health insurance or a managed care plan
6 that is amended, delivered, issued, or renewed after January
7 1, 2027 shall provide coverage for medically necessary laser
8 hair removal if the procedure is a prescribed medical
9 treatment in accordance with generally accepted standards of
10 medical care.
11 Section 30. The Health Maintenance Organization Act is
12 amended by changing Section 5-3 as follows:
13 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
14 (Text of Section before amendment by P.A. 103-808)
15 Sec. 5-3. Insurance Code provisions.
16 (a) Health Maintenance Organizations shall be subject to
17 the provisions of Sections 133, 134, 136, 137, 139, 140,
18 141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151,
19 152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
20 155.49, 352c, 355.2, 355.3, 355.6, 355b, 355c, 356f, 356g.5-1,
21 356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2, 356z.3a,
22 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
23 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18,
HB3248 Enrolled -9- LRB104 08344 BAB 18395 b
1 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24, 356z.25,
2 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32, 356z.33,
3 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39, 356z.40,
4 356z.40a, 356z.41, 356z.44, 356z.45, 356z.46, 356z.47,
5 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54, 356z.55,
6 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61, 356z.62,
7 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68, 356z.69,
8 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75, 356z.77,
9 356z.80, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b,
10 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A,
11 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
12 subsection (2) of Section 367, and Articles IIA, VIII 1/2,
13 XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
14 Illinois Insurance Code. Section 356z.80 of the Illinois
15 Insurance Code is not applicable to health care plans
16 providing health care services for persons who are enrolled
17 under Article V of the Illinois Public Aid Code.
18 (b) For purposes of the Illinois Insurance Code, except
19 for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
20 Health Maintenance Organizations in the following categories
21 are deemed to be "domestic companies":
22 (1) a corporation authorized under the Dental Service
23 Plan Act or the Voluntary Health Services Plans Act;
24 (2) a corporation organized under the laws of this
25 State; or
26 (3) a corporation organized under the laws of another
HB3248 Enrolled - 10 - LRB104 08344 BAB 18395 b
1 state, 30% or more of the enrollees of which are residents
2 of this State, except a corporation subject to
3 substantially the same requirements in its state of
4 organization as is a "domestic company" under Article VIII
5 1/2 of the Illinois Insurance Code.
6 (c) In considering the merger, consolidation, or other
7 acquisition of control of a Health Maintenance Organization
8 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
9 (1) the Director shall give primary consideration to
10 the continuation of benefits to enrollees and the
11 financial conditions of the acquired Health Maintenance
12 Organization after the merger, consolidation, or other
13 acquisition of control takes effect;
14 (2)(i) the criteria specified in subsection (1)(b) of
15 Section 131.8 of the Illinois Insurance Code shall not
16 apply and (ii) the Director, in making his determination
17 with respect to the merger, consolidation, or other
18 acquisition of control, need not take into account the
19 effect on competition of the merger, consolidation, or
20 other acquisition of control;
21 (3) the Director shall have the power to require the
22 following information:
23 (A) certification by an independent actuary of the
24 adequacy of the reserves of the Health Maintenance
25 Organization sought to be acquired;
26 (B) pro forma financial statements reflecting the
HB3248 Enrolled - 11 - LRB104 08344 BAB 18395 b
1 combined balance sheets of the acquiring company and
2 the Health Maintenance Organization sought to be
3 acquired as of the end of the preceding year and as of
4 a date 90 days prior to the acquisition, as well as pro
5 forma financial statements reflecting projected
6 combined operation for a period of 2 years;
7 (C) a pro forma business plan detailing an
8 acquiring party's plans with respect to the operation
9 of the Health Maintenance Organization sought to be
10 acquired for a period of not less than 3 years; and
11 (D) such other information as the Director shall
12 require.
13 (d) The provisions of Article VIII 1/2 of the Illinois
14 Insurance Code and this Section 5-3 shall apply to the sale by
15 any health maintenance organization of greater than 10% of its
16 enrollee population (including, without limitation, the health
17 maintenance organization's right, title, and interest in and
18 to its health care certificates).
19 (e) In considering any management contract or service
20 agreement subject to Section 141.1 of the Illinois Insurance
21 Code, the Director (i) shall, in addition to the criteria
22 specified in Section 141.2 of the Illinois Insurance Code,
23 take into account the effect of the management contract or
24 service agreement on the continuation of benefits to enrollees
25 and the financial condition of the health maintenance
26 organization to be managed or serviced, and (ii) need not take
HB3248 Enrolled - 12 - LRB104 08344 BAB 18395 b
1 into account the effect of the management contract or service
2 agreement on competition.
3 (f) Except for small employer groups as defined in the
4 Small Employer Rating, Renewability and Portability Health
5 Insurance Act and except for medicare supplement policies as
6 defined in Section 363 of the Illinois Insurance Code, a
7 Health Maintenance Organization may by contract agree with a
8 group or other enrollment unit to effect refunds or charge
9 additional premiums under the following terms and conditions:
10 (i) the amount of, and other terms and conditions with
11 respect to, the refund or additional premium are set forth
12 in the group or enrollment unit contract agreed in advance
13 of the period for which a refund is to be paid or
14 additional premium is to be charged (which period shall
15 not be less than one year); and
16 (ii) the amount of the refund or additional premium
17 shall not exceed 20% of the Health Maintenance
18 Organization's profitable or unprofitable experience with
19 respect to the group or other enrollment unit for the
20 period (and, for purposes of a refund or additional
21 premium, the profitable or unprofitable experience shall
22 be calculated taking into account a pro rata share of the
23 Health Maintenance Organization's administrative and
24 marketing expenses, but shall not include any refund to be
25 made or additional premium to be paid pursuant to this
26 subsection (f)). The Health Maintenance Organization and
HB3248 Enrolled - 13 - LRB104 08344 BAB 18395 b
1 the group or enrollment unit may agree that the profitable
2 or unprofitable experience may be calculated taking into
3 account the refund period and the immediately preceding 2
4 plan years.
5 The Health Maintenance Organization shall include a
6 statement in the evidence of coverage issued to each enrollee
7 describing the possibility of a refund or additional premium,
8 and upon request of any group or enrollment unit, provide to
9 the group or enrollment unit a description of the method used
10 to calculate (1) the Health Maintenance Organization's
11 profitable experience with respect to the group or enrollment
12 unit and the resulting refund to the group or enrollment unit
13 or (2) the Health Maintenance Organization's unprofitable
14 experience with respect to the group or enrollment unit and
15 the resulting additional premium to be paid by the group or
16 enrollment unit.
17 In no event shall the Illinois Health Maintenance
18 Organization Guaranty Association be liable to pay any
19 contractual obligation of an insolvent organization to pay any
20 refund authorized under this Section.
21 (g) Rulemaking authority to implement Public Act 95-1045,
22 if any, is conditioned on the rules being adopted in
23 accordance with all provisions of the Illinois Administrative
24 Procedure Act and all rules and procedures of the Joint
25 Committee on Administrative Rules; any purported rule not so
26 adopted, for whatever reason, is unauthorized.
HB3248 Enrolled - 14 - LRB104 08344 BAB 18395 b
1 (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
2 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
3 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
4 eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
5 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
6 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
7 eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
8 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
9 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
10 eff. 1-1-24; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24;
11 103-618, eff. 1-1-25; 103-649, eff. 1-1-25; 103-656, eff.
12 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24; 103-751,
13 eff. 8-2-24; 103-753, eff. 8-2-24; 103-758, eff. 1-1-25;
14 103-777, eff. 8-2-24; 103-914, eff. 1-1-25; 103-918, eff.
15 1-1-25; 103-1024, eff. 1-1-25; revised 9-26-24.)
16 (Text of Section after amendment by P.A. 103-808)
17 Sec. 5-3. Insurance Code provisions.
18 (a) Health Maintenance Organizations shall be subject to
19 the provisions of Sections 133, 134, 136, 137, 139, 140,
20 141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151,
21 152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
22 155.49, 352c, 355.2, 355.3, 355.6, 355b, 355c, 356f, 356g,
23 356g.5-1, 356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2,
24 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
25 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
HB3248 Enrolled - 15 - LRB104 08344 BAB 18395 b
1 356z.18, 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24,
2 356z.25, 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32,
3 356z.33, 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39,
4 356z.40, 356z.40a, 356z.41, 356z.44, 356z.45, 356z.46,
5 356z.47, 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54,
6 356z.55, 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61,
7 356z.62, 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68,
8 356z.69, 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75,
9 356z.77, 356z.80, 364, 364.01, 364.3, 367.2, 367.2-5, 367i,
10 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402,
11 403, 403A, 408, 408.2, 409, 412, 444, and 444.1, paragraph (c)
12 of subsection (2) of Section 367, and Articles IIA, VIII 1/2,
13 XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
14 Illinois Insurance Code.
15 (b) For purposes of the Illinois Insurance Code, except
16 for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
17 Health Maintenance Organizations in the following categories
18 are deemed to be "domestic companies":
19 (1) a corporation authorized under the Dental Service
20 Plan Act or the Voluntary Health Services Plans Act;
21 (2) a corporation organized under the laws of this
22 State; or
23 (3) a corporation organized under the laws of another
24 state, 30% or more of the enrollees of which are residents
25 of this State, except a corporation subject to
26 substantially the same requirements in its state of
HB3248 Enrolled - 16 - LRB104 08344 BAB 18395 b
1 organization as is a "domestic company" under Article VIII
2 1/2 of the Illinois Insurance Code.
3 (c) In considering the merger, consolidation, or other
4 acquisition of control of a Health Maintenance Organization
5 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
6 (1) the Director shall give primary consideration to
7 the continuation of benefits to enrollees and the
8 financial conditions of the acquired Health Maintenance
9 Organization after the merger, consolidation, or other
10 acquisition of control takes effect;
11 (2)(i) the criteria specified in subsection (1)(b) of
12 Section 131.8 of the Illinois Insurance Code shall not
13 apply and (ii) the Director, in making his determination
14 with respect to the merger, consolidation, or other
15 acquisition of control, need not take into account the
16 effect on competition of the merger, consolidation, or
17 other acquisition of control;
18 (3) the Director shall have the power to require the
19 following information:
20 (A) certification by an independent actuary of the
21 adequacy of the reserves of the Health Maintenance
22 Organization sought to be acquired;
23 (B) pro forma financial statements reflecting the
24 combined balance sheets of the acquiring company and
25 the Health Maintenance Organization sought to be
26 acquired as of the end of the preceding year and as of
HB3248 Enrolled - 17 - LRB104 08344 BAB 18395 b
1 a date 90 days prior to the acquisition, as well as pro
2 forma financial statements reflecting projected
3 combined operation for a period of 2 years;
4 (C) a pro forma business plan detailing an
5 acquiring party's plans with respect to the operation
6 of the Health Maintenance Organization sought to be
7 acquired for a period of not less than 3 years; and
8 (D) such other information as the Director shall
9 require.
10 (d) The provisions of Article VIII 1/2 of the Illinois
11 Insurance Code and this Section 5-3 shall apply to the sale by
12 any health maintenance organization of greater than 10% of its
13 enrollee population (including, without limitation, the health
14 maintenance organization's right, title, and interest in and
15 to its health care certificates).
16 (e) In considering any management contract or service
17 agreement subject to Section 141.1 of the Illinois Insurance
18 Code, the Director (i) shall, in addition to the criteria
19 specified in Section 141.2 of the Illinois Insurance Code,
20 take into account the effect of the management contract or
21 service agreement on the continuation of benefits to enrollees
22 and the financial condition of the health maintenance
23 organization to be managed or serviced, and (ii) need not take
24 into account the effect of the management contract or service
25 agreement on competition.
26 (f) Except for small employer groups as defined in the
HB3248 Enrolled - 18 - LRB104 08344 BAB 18395 b
1 Small Employer Rating, Renewability and Portability Health
2 Insurance Act and except for medicare supplement policies as
3 defined in Section 363 of the Illinois Insurance Code, a
4 Health Maintenance Organization may by contract agree with a
5 group or other enrollment unit to effect refunds or charge
6 additional premiums under the following terms and conditions:
7 (i) the amount of, and other terms and conditions with
8 respect to, the refund or additional premium are set forth
9 in the group or enrollment unit contract agreed in advance
10 of the period for which a refund is to be paid or
11 additional premium is to be charged (which period shall
12 not be less than one year); and
13 (ii) the amount of the refund or additional premium
14 shall not exceed 20% of the Health Maintenance
15 Organization's profitable or unprofitable experience with
16 respect to the group or other enrollment unit for the
17 period (and, for purposes of a refund or additional
18 premium, the profitable or unprofitable experience shall
19 be calculated taking into account a pro rata share of the
20 Health Maintenance Organization's administrative and
21 marketing expenses, but shall not include any refund to be
22 made or additional premium to be paid pursuant to this
23 subsection (f)). The Health Maintenance Organization and
24 the group or enrollment unit may agree that the profitable
25 or unprofitable experience may be calculated taking into
26 account the refund period and the immediately preceding 2
HB3248 Enrolled - 19 - LRB104 08344 BAB 18395 b
1 plan years.
2 The Health Maintenance Organization shall include a
3 statement in the evidence of coverage issued to each enrollee
4 describing the possibility of a refund or additional premium,
5 and upon request of any group or enrollment unit, provide to
6 the group or enrollment unit a description of the method used
7 to calculate (1) the Health Maintenance Organization's
8 profitable experience with respect to the group or enrollment
9 unit and the resulting refund to the group or enrollment unit
10 or (2) the Health Maintenance Organization's unprofitable
11 experience with respect to the group or enrollment unit and
12 the resulting additional premium to be paid by the group or
13 enrollment unit.
14 In no event shall the Illinois Health Maintenance
15 Organization Guaranty Association be liable to pay any
16 contractual obligation of an insolvent organization to pay any
17 refund authorized under this Section.
18 (g) Rulemaking authority to implement Public Act 95-1045,
19 if any, is conditioned on the rules being adopted in
20 accordance with all provisions of the Illinois Administrative
21 Procedure Act and all rules and procedures of the Joint
22 Committee on Administrative Rules; any purported rule not so
23 adopted, for whatever reason, is unauthorized.
24 (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
25 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
26 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
HB3248 Enrolled - 20 - LRB104 08344 BAB 18395 b
1 eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
2 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
3 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
4 eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
5 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
6 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
7 eff. 1-1-24; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24;
8 103-618, eff. 1-1-25; 103-649, eff. 1-1-25; 103-656, eff.
9 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24; 103-751,
10 eff. 8-2-24; 103-753, eff. 8-2-24; 103-758, eff. 1-1-25;
11 103-777, eff. 8-2-24; 103-808, eff. 1-1-26; 103-914, eff.
12 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; revised
13 11-26-24.)
14 Section 35. The Limited Health Service Organization Act is
15 amended by changing Section 4003 as follows:
16 (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
17 Sec. 4003. Illinois Insurance Code provisions. Limited
18 health service organizations shall be subject to the
19 provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
20 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151, 152, 153,
21 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 352c,
22 355.2, 355.3, 355b, 355d, 356m, 356q, 356v, 356z.4, 356z.4a,
23 356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.32,
24 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
HB3248 Enrolled - 21 - LRB104 08344 BAB 18395 b
1 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 356z.71,
2 356z.73, 356z.74, 356z.75, 356z.80, 364.3, 368a, 401, 401.1,
3 402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and
4 Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and
5 XXVI of the Illinois Insurance Code. Nothing in this Section
6 shall require a limited health care plan to cover any service
7 that is not a limited health service. For purposes of the
8 Illinois Insurance Code, except for Sections 444 and 444.1 and
9 Articles XIII and XIII 1/2, limited health service
10 organizations in the following categories are deemed to be
11 domestic companies:
12 (1) a corporation under the laws of this State; or
13 (2) 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 (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
20 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
21 1-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,
22 eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
23 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
24 1-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
25 eff. 1-1-24; 103-605, eff. 7-1-24; 103-649, eff. 1-1-25;
26 103-656, eff. 1-1-25; 103-700, eff. 1-1-25; 103-718, eff.
HB3248 Enrolled - 22 - LRB104 08344 BAB 18395 b
1 7-19-24; 103-751, eff. 8-2-24; 103-758, eff. 1-1-25; 103-832,
2 eff. 1-1-25; 103-1024, eff. 1-1-25; revised 11-26-24.)
3 Section 40. The Voluntary Health Services Plans Act is
4 amended by changing Section 10 as follows:
5 (215 ILCS 165/10) (from Ch. 32, par. 604)
6 Sec. 10. Application of Insurance Code provisions. Health
7 services plan corporations and all persons interested therein
8 or dealing therewith shall be subject to the provisions of
9 Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
10 143, 143.31, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3,
11 355b, 355d, 356g, 356g.5, 356g.5-1, 356m, 356q, 356r, 356t,
12 356u, 356u.10, 356v, 356w, 356x, 356y, 356z.1, 356z.2,
13 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
14 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
15 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
16 356z.32, 356z.32a, 356z.33, 356z.40, 356z.41, 356z.46,
17 356z.47, 356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59,
18 356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.71,
19 356z.72, 356z.74, 356z.75, 356z.77, 356z.80, 364.01, 364.3,
20 367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
21 and paragraphs (7) and (15) of Section 367 of the Illinois
22 Insurance Code.
23 Rulemaking authority to implement Public Act 95-1045, if
24 any, is conditioned on the rules being adopted in accordance
HB3248 Enrolled - 23 - LRB104 08344 BAB 18395 b
1 with all provisions of the Illinois Administrative Procedure
2 Act and all rules and procedures of the Joint Committee on
3 Administrative Rules; any purported rule not so adopted, for
4 whatever reason, is unauthorized.
5 (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
6 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
7 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
8 eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
9 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
10 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
11 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
12 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-656, eff.
13 1-1-25; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-753,
14 eff. 8-2-24; 103-758, eff. 1-1-25; 103-832, eff. 1-1-25;
15 103-914, eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff.
16 1-1-25; revised 11-26-24.)
17 Section 95. No acceleration or delay. Where this Act makes
18 changes in a statute that is represented in this Act by text
19 that is not yet or no longer in effect (for example, a Section
20 represented by multiple versions), the use of that text does
21 not accelerate or delay the taking effect of (i) the changes
22 made by this Act or (ii) provisions derived from any other
23 Public Act.Every fact on this page links to its source, starting with the official bill record.