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HB3677 Enrolled LRB104 09531 BAB 19594 b
1 AN ACT concerning business.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 Section 1. Short title. This Act may be cited as the
5 Complex Rehabilitation Technology Act.
6 Section 5. Definitions. As used in this Act:
7 "Complex manual wheelchair" means a manually driven
8 complex wheelchair that accommodates rehabilitative
9 accessories and features.
10 "Complex power wheelchair" means a power-driven wheelchair
11 that is classified as any of the following: (i) a Group 2 power
12 wheelchair with power options; (ii) a Group 3 power
13 wheelchair; (iii) a Group 4 power wheelchair; or (iv) a Group 5
14 power wheelchair.
15 "Complex rehabilitation technology" means an item that is
16 (i) individually configured for an individual to meet specific
17 and unique medical, physical, and functional needs and
18 capacities for basic activities of daily living and
19 instrumental activities of daily living and (ii) identified as
20 medically necessary. "Complex rehabilitation technology"
21 includes a complex wheelchair.
22 "Complex wheelchair" means a complex manual wheelchair or
23 a complex power wheelchair.
HB3677 Enrolled -2- LRB104 09531 BAB 19594 b
1 "Qualified complex rehabilitation technology
2 professional" means an individual who is certified as an
3 assistive technology professional (ATP) by the Rehabilitation
4 Engineering and Assistive Technology Society of North America
5 (RESNA).
6 Section 10. Requirements for suppliers of complex
7 wheelchairs. A person who sells or offers for sale complex
8 rehabilitation technology in this State shall:
9 (1) be accredited by a recognized accrediting
10 organization as a supplier of complex rehabilitation
11 technology;
12 (2) employ at least one employee to whom the person
13 furnishes an IRS W-2 form and who is a qualified complex
14 rehabilitation technology professional, in order to
15 analyze the needs and capacities of the complex needs of
16 consumers in consultation with qualified health care
17 professionals, participate in the selection of an
18 appropriate complex rehabilitation technology for those
19 needs and capacities of the complex needs consumer, and
20 provide training in the proper use of the complex
21 rehabilitation technology;
22 (3) require a qualified complex rehabilitation
23 technology professional to be physically present for the
24 evaluation and determination of appropriate complex
25 rehabilitation technology for a complex needs consumer;
HB3677 Enrolled -3- LRB104 09531 BAB 19594 b
1 (4) be capable of providing service and repair by
2 trained technicians for all complex rehabilitation
3 technology it sells; and
4 (5) provide written information at the time of
5 delivery of the complex wheelchair to the complex needs
6 consumer stating how the complex needs consumer may
7 receive service and repair for the complex rehabilitation
8 technology.
9 Section 15. Repair services. A supplier of complex
10 wheelchairs shall offer service and repairs to the consumer of
11 the complex wheelchair for the useful life expectancy of the
12 complex wheelchair, unless:
13 (1) the consumer has moved outside of the original
14 supplier's service area;
15 (2) the damage that requires repair is the result of
16 consumer abuse or misuse of the equipment that restricts
17 coverage by the client's health plan, and the client
18 refuses to pay for the repairs; or
19 (3) the consumer or the consumer's representative
20 poses a potential threat to the health and safety of the
21 supplier or is otherwise abusive.
22 Section 25. Enforcement. A violation of any of the
23 provisions of this Act is an unlawful practice under the
24 Consumer Fraud and Deceptive Business Practices Act. All
HB3677 Enrolled -4- LRB104 09531 BAB 19594 b
1 remedies, penalties, and authority granted by that Act shall
2 be available for the enforcement of this Act.
3 Section 30. Applicability. This Act applies with respect
4 to complex wheelchairs sold or in use on or after the effective
5 date of this Act.
6 Section 900. The State Employees Group Insurance Act of
7 1971 is amended by changing Section 6.11 as follows:
8 (5 ILCS 375/6.11)
9 Sec. 6.11. Required health benefits; Illinois Insurance
10 Code requirements. The program of health benefits shall
11 provide the post-mastectomy care benefits required to be
12 covered by a policy of accident and health insurance under
13 Section 356t of the Illinois Insurance Code. The program of
14 health benefits shall provide the coverage required under
15 Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10,
16 356w, 356x, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
17 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
18 356z.17, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
19 356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
20 356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59,
21 356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, and
22 356z.70, and 356z.71, 356z.74, 356z.76, 356z.77, and 356z.80
23 of the Illinois Insurance Code. The program of health benefits
HB3677 Enrolled -5- LRB104 09531 BAB 19594 b
1 must comply with Sections 155.22a, 155.37, 355b, 356z.19,
2 370c, and 370c.1 and Article XXXIIB of the Illinois Insurance
3 Code. The program of health benefits shall provide the
4 coverage required under Section 356m of the Illinois Insurance
5 Code and, for the employees of the State Employee Group
6 Insurance Program only, the coverage as also provided in
7 Section 6.11B of this Act. The Department of Insurance shall
8 enforce the requirements of this Section with respect to
9 Sections 370c and 370c.1 of the Illinois Insurance Code; all
10 other requirements of this Section shall be enforced by the
11 Department of Central Management Services.
12 Rulemaking authority to implement Public Act 95-1045, if
13 any, is conditioned on the rules being adopted in accordance
14 with all provisions of the Illinois Administrative Procedure
15 Act and all rules and procedures of the Joint Committee on
16 Administrative Rules; any purported rule not so adopted, for
17 whatever reason, is unauthorized.
18 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
19 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
20 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768,
21 eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
22 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
23 1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84,
24 eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24;
25 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff.
26 8-11-23; 103-605, eff. 7-1-24; 103-718, eff. 7-19-24; 103-751,
HB3677 Enrolled -6- LRB104 09531 BAB 19594 b
1 eff. 8-2-24; 103-870, eff. 1-1-25; 103-914, eff. 1-1-25;
2 103-918, eff. 1-1-25; 103-951, eff. 1-1-25; 103-1024, eff.
3 1-1-25; revised 11-26-24.)
4 Section 905. The Counties Code is amended by changing
5 Section 5-1069.3 as follows:
6 (55 ILCS 5/5-1069.3)
7 Sec. 5-1069.3. Required health benefits. If a county,
8 including a home rule county, is a self-insurer for purposes
9 of providing health insurance coverage for its employees, the
10 coverage shall include coverage for the post-mastectomy care
11 benefits required to be covered by a policy of accident and
12 health insurance under Section 356t and the coverage required
13 under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u,
14 356u.10, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9,
15 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
16 356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 356z.33, 356z.36,
17 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
18 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61,
19 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70, and 356z.71,
20 356z.74, 356z.77, and 356z.80 of the Illinois Insurance Code.
21 The coverage shall comply with Sections 155.22a, 355b,
22 356z.19, and 370c of the Illinois Insurance Code. The
23 Department of Insurance shall enforce the requirements of this
24 Section. The requirement that health benefits be covered as
HB3677 Enrolled -7- LRB104 09531 BAB 19594 b
1 provided in this Section is an exclusive power and function of
2 the State and is a denial and limitation under Article VII,
3 Section 6, subsection (h) of the Illinois Constitution. A home
4 rule county to which this Section applies must comply with
5 every provision of this Section.
6 Rulemaking authority to implement Public Act 95-1045, if
7 any, is conditioned on the rules being adopted in accordance
8 with all provisions of the Illinois Administrative Procedure
9 Act and all rules and procedures of the Joint Committee on
10 Administrative Rules; any purported rule not so adopted, for
11 whatever reason, is unauthorized.
12 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
13 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
14 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
15 eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
16 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
17 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
18 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
19 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff.
20 7-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-914,
21 eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25;
22 revised 11-26-24.)
23 Section 910. The Illinois Municipal Code is amended by
24 changing Section 10-4-2.3 as follows:
HB3677 Enrolled -8- LRB104 09531 BAB 19594 b
1 (65 ILCS 5/10-4-2.3)
2 Sec. 10-4-2.3. Required health benefits. If a
3 municipality, including a home rule municipality, is a
4 self-insurer for purposes of providing health insurance
5 coverage for its employees, the coverage shall include
6 coverage for the post-mastectomy care benefits required to be
7 covered by a policy of accident and health insurance under
8 Section 356t and the coverage required under Sections 356g,
9 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10, 356w, 356x,
10 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
11 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
12 356z.29, 356z.30, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
13 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
14 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64,
15 356z.67, 356z.68, and 356z.70, and 356z.71, 356z.74, 356z.77,
16 and 356z.80 of the Illinois Insurance Code. The coverage shall
17 comply with Sections 155.22a, 355b, 356z.19, and 370c of the
18 Illinois Insurance Code. The Department of Insurance shall
19 enforce the requirements of this Section. The requirement that
20 health benefits be covered as provided in this is an exclusive
21 power and function of the State and is a denial and limitation
22 under Article VII, Section 6, subsection (h) of the Illinois
23 Constitution. A home rule municipality to which this Section
24 applies must comply with every provision of this Section.
25 Rulemaking authority to implement Public Act 95-1045, if
26 any, is conditioned on the rules being adopted in accordance
HB3677 Enrolled -9- LRB104 09531 BAB 19594 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; 102-103, eff. 1-1-22;
6 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
7 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
8 eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
9 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 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;
12 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff.
13 7-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-914,
14 eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25;
15 revised 11-26-24.)
16 Section 915. The School Code is amended by changing
17 Section 10-22.3f as follows:
18 (105 ILCS 5/10-22.3f)
19 Sec. 10-22.3f. Required health benefits. Insurance
20 protection and benefits for employees shall provide the
21 post-mastectomy care benefits required to be covered by a
22 policy of accident and health insurance under Section 356t and
23 the coverage required under Sections 356g, 356g.5, 356g.5-1,
24 356m, 356q, 356u, 356u.10, 356w, 356x, 356z.4, 356z.4a,
HB3677 Enrolled - 10 - LRB104 09531 BAB 19594 b
1 356z.6, 356z.8, 356z.9, 356z.11, 356z.12, 356z.13, 356z.14,
2 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
3 356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
4 356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60,
5 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70, and
6 356z.71, 356z.74, 356z.77, and 356z.80 of the Illinois
7 Insurance Code. Insurance policies shall comply with Section
8 356z.19 of the Illinois Insurance Code. The coverage shall
9 comply with Sections 155.22a, 355b, and 370c of the Illinois
10 Insurance Code. The Department of Insurance shall enforce the
11 requirements of this Section.
12 Rulemaking authority to implement Public Act 95-1045, if
13 any, is conditioned on the rules being adopted in accordance
14 with all provisions of the Illinois Administrative Procedure
15 Act and all rules and procedures of the Joint Committee on
16 Administrative Rules; any purported rule not so adopted, for
17 whatever reason, is unauthorized.
18 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
19 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
20 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,
21 eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
22 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.
23 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,
24 eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;
25 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718, eff.
26 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25; 103-918,
HB3677 Enrolled - 11 - LRB104 09531 BAB 19594 b
1 eff. 1-1-25; 103-1024, eff. 1-1-25; revised 11-26-24.)
2 Section 920. The Illinois Insurance Code is amended by
3 adding Section 356z.80 as follows:
4 (215 ILCS 5/356z.80 new)
5 Sec. 356z.80. Coverage for complex wheelchair service and
6 repair.
7 (a) As used in this Section:
8 "Complex rehabilitation technology" means a medically
9 necessary complex wheelchair and associated accessories that
10 is individually configured for an individual to meet specific
11 and unique medical, physical, and functional needs and
12 capacities for basic activities of daily living and
13 instrumental activities of daily living.
14 "Complex wheelchair" has the meaning given in the Complex
15 Rehabilitation Technology Act.
16 "Qualified complex rehabilitation technology supplier"
17 means a person who meets the requirements of Section 10 of the
18 Complex Rehabilitation Technology Act.
19 "Repair" means the repair or replacement of a deficient,
20 broken, or otherwise malfunctioning part, component, hardware,
21 or software, when the deficient, broken, or otherwise
22 malfunctioning state of such part, component, hardware, or
23 software results in the incapacity of or otherwise diminished
24 capacity for use of a complex rehabilitation technology.
HB3677 Enrolled - 12 - LRB104 09531 BAB 19594 b
1 (b) A group or individual policy of accident and health
2 insurance or a managed care plan that is amended, delivered,
3 issued, or renewed on or after January 1, 2027 and that
4 provides coverage for complex rehabilitation technology shall
5 not require prior authorization, medical documentation, or
6 proof of continued need to complete medically necessary
7 repairs for consumer-owned complex rehabilitation technology
8 unless:
9 (1) the repairs are covered under a manufacturer's
10 warranty;
11 (2) the cumulative cost of the repairs exceeds 75% of
12 the cost to replace the complex rehabilitation technology;
13 or
14 (3) the complex rehabilitation technology in need of
15 repair is subject to replacement because the age of the
16 complex rehabilitation technology exceeds or is within one
17 year of the expiration of the 5-year reasonable useful
18 life of the complex rehabilitation technology.
19 (c) Notwithstanding subsection (b), a Medicaid managed
20 care plan amended, delivered, issued, or renewed on or after
21 January 1, 2027 and that provides coverage for complex
22 rehabilitation technology shall not require prior
23 authorization, medical documentation, or proof of continued
24 need to complete medically necessary repairs for
25 consumer-owned complex rehabilitation technology under the
26 total value of $1,500. Acceptance or denial of repairs of
HB3677 Enrolled - 13 - LRB104 09531 BAB 19594 b
1 $1,500 or more must be made within 7 days of request of
2 preauthorization.
3 Documentation of any repairs completed for consumer-owned
4 complex rehabilitation technology shall be maintained by the
5 qualified complex rehabilitation technology supplier
6 conducting the repairs and must be made available to the
7 insurer upon request.
8 (d) A group or individual policy of accident and health
9 insurance or a managed care plan that is amended, delivered,
10 issued, or renewed on or after January 1, 2027 and that
11 provides coverage for a complex rehabilitation technology
12 shall provide coverage for rented complex rehabilitation
13 technology during the time the primary complex rehabilitation
14 technology is under repair consistent with the provisions for
15 consumer-owned complex rehabilitation technology in subsection
16 (b).
17 (e) If, after a post-service review for medical necessity,
18 an insurer finds that any repair of an item not covered at
19 initial issue of the complex wheelchair was not medically
20 necessary, the insurer and owner shall be held harmless for
21 the cost of the repair and the qualified complex
22 rehabilitation technology supplier that conducted the repair
23 shall be liable for the cost of repair.
24 Section 925. The Health Maintenance Organization Act is
25 amended by changing Section 5-3 as follows:
HB3677 Enrolled - 14 - LRB104 09531 BAB 19594 b
1 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
2 (Text of Section before amendment by P.A. 103-808)
3 Sec. 5-3. Insurance Code provisions.
4 (a) Health Maintenance Organizations shall be subject to
5 the provisions of Sections 133, 134, 136, 137, 139, 140,
6 141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151,
7 152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
8 155.49, 352c, 355.2, 355.3, 355.6, 355b, 355c, 356f, 356g.5-1,
9 356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2, 356z.3a,
10 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
11 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18,
12 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24, 356z.25,
13 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32, 356z.33,
14 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39, 356z.40,
15 356z.40a, 356z.41, 356z.44, 356z.45, 356z.46, 356z.47,
16 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54, 356z.55,
17 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61, 356z.62,
18 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68, 356z.69,
19 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75, 356z.77,
20 356z.80, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b,
21 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A,
22 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
23 subsection (2) of Section 367, and Articles IIA, VIII 1/2,
24 XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
25 Illinois Insurance Code.
HB3677 Enrolled - 15 - LRB104 09531 BAB 19594 b
1 (b) For purposes of the Illinois Insurance Code, except
2 for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
3 Health Maintenance Organizations in the following categories
4 are deemed to be "domestic companies":
5 (1) a corporation authorized under the Dental Service
6 Plan Act or the Voluntary Health Services Plans Act;
7 (2) a corporation organized under the laws of this
8 State; or
9 (3) a corporation organized under the laws of another
10 state, 30% or more of the enrollees of which are residents
11 of this State, except a corporation subject to
12 substantially the same requirements in its state of
13 organization as is a "domestic company" under Article VIII
14 1/2 of the Illinois Insurance Code.
15 (c) In considering the merger, consolidation, or other
16 acquisition of control of a Health Maintenance Organization
17 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
18 (1) the Director shall give primary consideration to
19 the continuation of benefits to enrollees and the
20 financial conditions of the acquired Health Maintenance
21 Organization after the merger, consolidation, or other
22 acquisition of control takes effect;
23 (2)(i) the criteria specified in subsection (1)(b) of
24 Section 131.8 of the Illinois Insurance Code shall not
25 apply and (ii) the Director, in making his determination
26 with respect to the merger, consolidation, or other
HB3677 Enrolled - 16 - LRB104 09531 BAB 19594 b
1 acquisition of control, need not take into account the
2 effect on competition of the merger, consolidation, or
3 other acquisition of control;
4 (3) the Director shall have the power to require the
5 following information:
6 (A) certification by an independent actuary of the
7 adequacy of the reserves of the Health Maintenance
8 Organization sought to be acquired;
9 (B) pro forma financial statements reflecting the
10 combined balance sheets of the acquiring company and
11 the Health Maintenance Organization sought to be
12 acquired as of the end of the preceding year and as of
13 a date 90 days prior to the acquisition, as well as pro
14 forma financial statements reflecting projected
15 combined operation for a period of 2 years;
16 (C) a pro forma business plan detailing an
17 acquiring party's plans with respect to the operation
18 of the Health Maintenance Organization sought to be
19 acquired for a period of not less than 3 years; and
20 (D) such other information as the Director shall
21 require.
22 (d) The provisions of Article VIII 1/2 of the Illinois
23 Insurance Code and this Section 5-3 shall apply to the sale by
24 any health maintenance organization of greater than 10% of its
25 enrollee population (including, without limitation, the health
26 maintenance organization's right, title, and interest in and
HB3677 Enrolled - 17 - LRB104 09531 BAB 19594 b
1 to its health care certificates).
2 (e) In considering any management contract or service
3 agreement subject to Section 141.1 of the Illinois Insurance
4 Code, the Director (i) shall, in addition to the criteria
5 specified in Section 141.2 of the Illinois Insurance Code,
6 take into account the effect of the management contract or
7 service agreement on the continuation of benefits to enrollees
8 and the financial condition of the health maintenance
9 organization to be managed or serviced, and (ii) need not take
10 into account the effect of the management contract or service
11 agreement on competition.
12 (f) Except for small employer groups as defined in the
13 Small Employer Rating, Renewability and Portability Health
14 Insurance Act and except for medicare supplement policies as
15 defined in Section 363 of the Illinois Insurance Code, a
16 Health Maintenance Organization may by contract agree with a
17 group or other enrollment unit to effect refunds or charge
18 additional premiums under the following terms and conditions:
19 (i) the amount of, and other terms and conditions with
20 respect to, the refund or additional premium are set forth
21 in the group or enrollment unit contract agreed in advance
22 of the period for which a refund is to be paid or
23 additional premium is to be charged (which period shall
24 not be less than one year); and
25 (ii) the amount of the refund or additional premium
26 shall not exceed 20% of the Health Maintenance
HB3677 Enrolled - 18 - LRB104 09531 BAB 19594 b
1 Organization's profitable or unprofitable experience with
2 respect to the group or other enrollment unit for the
3 period (and, for purposes of a refund or additional
4 premium, the profitable or unprofitable experience shall
5 be calculated taking into account a pro rata share of the
6 Health Maintenance Organization's administrative and
7 marketing expenses, but shall not include any refund to be
8 made or additional premium to be paid pursuant to this
9 subsection (f)). The Health Maintenance Organization and
10 the group or enrollment unit may agree that the profitable
11 or unprofitable experience may be calculated taking into
12 account the refund period and the immediately preceding 2
13 plan years.
14 The Health Maintenance Organization shall include a
15 statement in the evidence of coverage issued to each enrollee
16 describing the possibility of a refund or additional premium,
17 and upon request of any group or enrollment unit, provide to
18 the group or enrollment unit a description of the method used
19 to calculate (1) the Health Maintenance Organization's
20 profitable experience with respect to the group or enrollment
21 unit and the resulting refund to the group or enrollment unit
22 or (2) the Health Maintenance Organization's unprofitable
23 experience with respect to the group or enrollment unit and
24 the resulting additional premium to be paid by the group or
25 enrollment unit.
26 In no event shall the Illinois Health Maintenance
HB3677 Enrolled - 19 - LRB104 09531 BAB 19594 b
1 Organization Guaranty Association be liable to pay any
2 contractual obligation of an insolvent organization to pay any
3 refund authorized under this Section.
4 (g) Rulemaking authority to implement Public Act 95-1045,
5 if any, is conditioned on the rules being adopted in
6 accordance with all provisions of the Illinois Administrative
7 Procedure Act and all rules and procedures of the Joint
8 Committee on Administrative Rules; any purported rule not so
9 adopted, for whatever reason, is unauthorized.
10 (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
11 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
12 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
13 eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
14 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
15 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
16 eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
17 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
18 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
19 eff. 1-1-24; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24;
20 103-618, eff. 1-1-25; 103-649, eff. 1-1-25; 103-656, eff.
21 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24; 103-751,
22 eff. 8-2-24; 103-753, eff. 8-2-24; 103-758, eff. 1-1-25;
23 103-777, eff. 8-2-24; 103-914, eff. 1-1-25; 103-918, eff.
24 1-1-25; 103-1024, eff. 1-1-25; revised 9-26-24.)
25 (Text of Section after amendment by P.A. 103-808)
HB3677 Enrolled - 20 - LRB104 09531 BAB 19594 b
1 Sec. 5-3. Insurance Code provisions.
2 (a) Health Maintenance Organizations shall be subject to
3 the provisions of Sections 133, 134, 136, 137, 139, 140,
4 141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151,
5 152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
6 155.49, 352c, 355.2, 355.3, 355.6, 355b, 355c, 356f, 356g,
7 356g.5-1, 356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2,
8 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
9 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
10 356z.18, 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24,
11 356z.25, 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32,
12 356z.33, 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39,
13 356z.40, 356z.40a, 356z.41, 356z.44, 356z.45, 356z.46,
14 356z.47, 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54,
15 356z.55, 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61,
16 356z.62, 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68,
17 356z.69, 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75,
18 356z.77, 356z.80, 364, 364.01, 364.3, 367.2, 367.2-5, 367i,
19 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402,
20 403, 403A, 408, 408.2, 409, 412, 444, and 444.1, paragraph (c)
21 of subsection (2) of Section 367, and Articles IIA, VIII 1/2,
22 XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
23 Illinois Insurance Code.
24 (b) For purposes of the Illinois Insurance Code, except
25 for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
26 Health Maintenance Organizations in the following categories
HB3677 Enrolled - 21 - LRB104 09531 BAB 19594 b
1 are deemed to be "domestic companies":
2 (1) a corporation authorized under the Dental Service
3 Plan Act or the Voluntary Health Services Plans Act;
4 (2) a corporation organized under the laws of this
5 State; or
6 (3) a corporation organized under the laws of another
7 state, 30% or more of the enrollees of which are residents
8 of this State, except a corporation subject to
9 substantially the same requirements in its state of
10 organization as is a "domestic company" under Article VIII
11 1/2 of the Illinois Insurance Code.
12 (c) In considering the merger, consolidation, or other
13 acquisition of control of a Health Maintenance Organization
14 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
15 (1) the Director shall give primary consideration to
16 the continuation of benefits to enrollees and the
17 financial conditions of the acquired Health Maintenance
18 Organization after the merger, consolidation, or other
19 acquisition of control takes effect;
20 (2)(i) the criteria specified in subsection (1)(b) of
21 Section 131.8 of the Illinois Insurance Code shall not
22 apply and (ii) the Director, in making his determination
23 with respect to the merger, consolidation, or other
24 acquisition of control, need not take into account the
25 effect on competition of the merger, consolidation, or
26 other acquisition of control;
HB3677 Enrolled - 22 - LRB104 09531 BAB 19594 b
1 (3) the Director shall have the power to require the
2 following information:
3 (A) certification by an independent actuary of the
4 adequacy of the reserves of the Health Maintenance
5 Organization sought to be acquired;
6 (B) pro forma financial statements reflecting the
7 combined balance sheets of the acquiring company and
8 the Health Maintenance Organization sought to be
9 acquired as of the end of the preceding year and as of
10 a date 90 days prior to the acquisition, as well as pro
11 forma financial statements reflecting projected
12 combined operation for a period of 2 years;
13 (C) a pro forma business plan detailing an
14 acquiring party's plans with respect to the operation
15 of the Health Maintenance Organization sought to be
16 acquired for a period of not less than 3 years; and
17 (D) such other information as the Director shall
18 require.
19 (d) The provisions of Article VIII 1/2 of the Illinois
20 Insurance Code and this Section 5-3 shall apply to the sale by
21 any health maintenance organization of greater than 10% of its
22 enrollee population (including, without limitation, the health
23 maintenance organization's right, title, and interest in and
24 to its health care certificates).
25 (e) In considering any management contract or service
26 agreement subject to Section 141.1 of the Illinois Insurance
HB3677 Enrolled - 23 - LRB104 09531 BAB 19594 b
1 Code, the Director (i) shall, in addition to the criteria
2 specified in Section 141.2 of the Illinois Insurance Code,
3 take into account the effect of the management contract or
4 service agreement on the continuation of benefits to enrollees
5 and the financial condition of the health maintenance
6 organization to be managed or serviced, and (ii) need not take
7 into account the effect of the management contract or service
8 agreement on competition.
9 (f) Except for small employer groups as defined in the
10 Small Employer Rating, Renewability and Portability Health
11 Insurance Act and except for medicare supplement policies as
12 defined in Section 363 of the Illinois Insurance Code, a
13 Health Maintenance Organization may by contract agree with a
14 group or other enrollment unit to effect refunds or charge
15 additional premiums under the following terms and conditions:
16 (i) the amount of, and other terms and conditions with
17 respect to, the refund or additional premium are set forth
18 in the group or enrollment unit contract agreed in advance
19 of the period for which a refund is to be paid or
20 additional premium is to be charged (which period shall
21 not be less than one year); and
22 (ii) the amount of the refund or additional premium
23 shall not exceed 20% of the Health Maintenance
24 Organization's profitable or unprofitable experience with
25 respect to the group or other enrollment unit for the
26 period (and, for purposes of a refund or additional
HB3677 Enrolled - 24 - LRB104 09531 BAB 19594 b
1 premium, the profitable or unprofitable experience shall
2 be calculated taking into account a pro rata share of the
3 Health Maintenance Organization's administrative and
4 marketing expenses, but shall not include any refund to be
5 made or additional premium to be paid pursuant to this
6 subsection (f)). The Health Maintenance Organization and
7 the group or enrollment unit may agree that the profitable
8 or unprofitable experience may be calculated taking into
9 account the refund period and the immediately preceding 2
10 plan years.
11 The Health Maintenance Organization shall include a
12 statement in the evidence of coverage issued to each enrollee
13 describing the possibility of a refund or additional premium,
14 and upon request of any group or enrollment unit, provide to
15 the group or enrollment unit a description of the method used
16 to calculate (1) the Health Maintenance Organization's
17 profitable experience with respect to the group or enrollment
18 unit and the resulting refund to the group or enrollment unit
19 or (2) the Health Maintenance Organization's unprofitable
20 experience with respect to the group or enrollment unit and
21 the resulting additional premium to be paid by the group or
22 enrollment unit.
23 In no event shall the Illinois Health Maintenance
24 Organization Guaranty Association be liable to pay any
25 contractual obligation of an insolvent organization to pay any
26 refund authorized under this Section.
HB3677 Enrolled - 25 - LRB104 09531 BAB 19594 b
1 (g) Rulemaking authority to implement Public Act 95-1045,
2 if any, is conditioned on the rules being adopted in
3 accordance with all provisions of the Illinois Administrative
4 Procedure Act and all rules and procedures of the Joint
5 Committee on Administrative Rules; any purported rule not so
6 adopted, for whatever reason, is unauthorized.
7 (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
8 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
9 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
10 eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
11 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
12 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
13 eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
14 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
15 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
16 eff. 1-1-24; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24;
17 103-618, eff. 1-1-25; 103-649, eff. 1-1-25; 103-656, eff.
18 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24; 103-751,
19 eff. 8-2-24; 103-753, eff. 8-2-24; 103-758, eff. 1-1-25;
20 103-777, eff. 8-2-24; 103-808, eff. 1-1-26; 103-914, eff.
21 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; revised
22 11-26-24.)
23 Section 930. The Limited Health Service Organization Act
24 is amended by changing Section 4003 as follows:
HB3677 Enrolled - 26 - LRB104 09531 BAB 19594 b
1 (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
2 Sec. 4003. Illinois Insurance Code provisions. Limited
3 health service organizations shall be subject to the
4 provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
5 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151, 152, 153,
6 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 352c,
7 355.2, 355.3, 355b, 355d, 356m, 356q, 356v, 356z.4, 356z.4a,
8 356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.32,
9 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
10 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 356z.71,
11 356z.73, 356z.74, 356z.75, 356z.80, 364.3, 368a, 401, 401.1,
12 402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and
13 Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and
14 XXVI of the Illinois Insurance Code. Nothing in this Section
15 shall require a limited health care plan to cover any service
16 that is not a limited health service. For purposes of the
17 Illinois Insurance Code, except for Sections 444 and 444.1 and
18 Articles XIII and XIII 1/2, limited health service
19 organizations in the following categories are deemed to be
20 domestic companies:
21 (1) a corporation under the laws of this State; or
22 (2) a corporation organized under the laws of another
23 state, 30% or more of the enrollees of which are residents
24 of this State, except a corporation subject to
25 substantially the same requirements in its state of
26 organization as is a domestic company under Article VIII
HB3677 Enrolled - 27 - LRB104 09531 BAB 19594 b
1 1/2 of the Illinois Insurance Code.
2 (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
3 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
4 1-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,
5 eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
6 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
7 1-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
8 eff. 1-1-24; 103-605, eff. 7-1-24; 103-649, eff. 1-1-25;
9 103-656, eff. 1-1-25; 103-700, eff. 1-1-25; 103-718, eff.
10 7-19-24; 103-751, eff. 8-2-24; 103-758, eff. 1-1-25; 103-832,
11 eff. 1-1-25; 103-1024, eff. 1-1-25; revised 11-26-24.)
12 Section 935. The Voluntary Health Services Plans Act is
13 amended by changing Section 10 as follows:
14 (215 ILCS 165/10) (from Ch. 32, par. 604)
15 Sec. 10. Application of Insurance Code provisions. Health
16 services plan corporations and all persons interested therein
17 or dealing therewith shall be subject to the provisions of
18 Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
19 143, 143.31, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3,
20 355b, 355d, 356g, 356g.5, 356g.5-1, 356m, 356q, 356r, 356t,
21 356u, 356u.10, 356v, 356w, 356x, 356y, 356z.1, 356z.2,
22 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
23 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
24 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
HB3677 Enrolled - 28 - LRB104 09531 BAB 19594 b
1 356z.32, 356z.32a, 356z.33, 356z.40, 356z.41, 356z.46,
2 356z.47, 356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59,
3 356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.71,
4 356z.72, 356z.74, 356z.75, 356z.77, 356z.80, 364.01, 364.3,
5 367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
6 and paragraphs (7) and (15) of Section 367 of the Illinois
7 Insurance Code.
8 Rulemaking authority to implement Public Act 95-1045, if
9 any, is conditioned on the rules being adopted in accordance
10 with all provisions of the Illinois Administrative Procedure
11 Act and all rules and procedures of the Joint Committee on
12 Administrative Rules; any purported rule not so adopted, for
13 whatever reason, is unauthorized.
14 (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
15 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
16 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
17 eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
18 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
19 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
20 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
21 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-656, eff.
22 1-1-25; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-753,
23 eff. 8-2-24; 103-758, eff. 1-1-25; 103-832, eff. 1-1-25;
24 103-914, eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff.
25 1-1-25; revised 11-26-24.)
HB3677 Enrolled - 29 - LRB104 09531 BAB 19594 b
1 Section 940. The Illinois Public Aid Code is amended by
2 changing Section 5-16.8 as follows:
3 (305 ILCS 5/5-16.8)
4 Sec. 5-16.8. Required health benefits. The medical
5 assistance program shall (i) provide the post-mastectomy care
6 benefits required to be covered by a policy of accident and
7 health insurance under Section 356t and the coverage required
8 under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
9 356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
10 356z.47, 356z.51, 356z.53, 356z.59, 356z.60, 356z.61, 356z.64,
11 and 356z.67, and 356z.71, 356z.75, and 356z.80 of the Illinois
12 Insurance Code, (ii) be subject to the provisions of Sections
13 356z.19, 356z.44, 356z.49, 364.01, 370c, and 370c.1 of the
14 Illinois Insurance Code, and (iii) be subject to the
15 provisions of subsection (d-5) of Section 10 of the Network
16 Adequacy and Transparency Act.
17 The Department, by rule, shall adopt a model similar to
18 the requirements of Section 356z.39 of the Illinois Insurance
19 Code.
20 On and after July 1, 2012, the Department shall reduce any
21 rate of reimbursement for services or other payments or alter
22 any methodologies authorized by this Code to reduce any rate
23 of reimbursement for services or other payments in accordance
24 with Section 5-5e.
25 To ensure full access to the benefits set forth in this
HB3677 Enrolled - 30 - LRB104 09531 BAB 19594 b
1 Section, on and after January 1, 2016, the Department shall
2 ensure that provider and hospital reimbursement for
3 post-mastectomy care benefits required under this Section are
4 no lower than the Medicare reimbursement rate.
5 (Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22;
6 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff.
7 1-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813,
8 eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23;
9 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
10 1-1-24; 103-420, eff. 1-1-24; 103-605, eff. 7-1-24; 103-703,
11 eff. 1-1-25; 103-758, eff. 1-1-25; 103-1024, eff. 1-1-25;
12 revised 11-26-24.)
13 Section 945. The Consumer Fraud and Deceptive Business
14 Practices Act is amended by adding Section 2HHHH as follows:
15 (815 ILCS 505/2HHHH new)
16 Sec. 2HHHH. Violations of the Complex Rehabilitation
17 Technology Act. A person who violates the Complex
18 Rehabilitation Technology Act commits an unlawful practice
19 within the meaning of this Act.
20 Section 995. No acceleration or delay. Where this Act
21 makes changes in a statute that is represented in this Act by
22 text that is not yet or no longer in effect (for example, a
23 Section represented by multiple versions), the use of that
HB3677 Enrolled - 31 - LRB104 09531 BAB 19594 b
1 text does not accelerate or delay the taking effect of (i) the
2 changes made by this Act or (ii) provisions derived from any
3 other Public Act.
4 Section 999. Effective date. This Act takes effect January
5 1, 2026.Every fact on this page links to its source, starting with the official bill record.