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SB2762 Enrolled LRB104 16499 BAB 29895 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 Counties Code is amended by changing
5 Section 5-1069.3 as follows:
6 (55 ILCS 5/5-1069.3)
7 (Text of Section before amendment by P.A. 104-446)
8 Sec. 5-1069.3. Required health benefits. If a county,
9 including a home rule county, is a self-insurer for purposes
10 of providing health insurance coverage for its employees, the
11 coverage shall include coverage for the post-mastectomy care
12 benefits required to be covered by a policy of accident and
13 health insurance under Section 356t and the coverage required
14 under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u,
15 356u.10, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9,
16 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
17 356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 356z.33, 356z.36,
18 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
19 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61,
20 356z.62, 356z.64, 356z.67, 356z.68, 356z.70, 356z.71, 356z.74,
21 and 356z.77, 356z.79, and 356z.80, 356z.81, 356z.82, 356z.83,
22 356z.84, 356z.85, 356z.88, and 356z.89 of the Illinois
23 Insurance Code. The coverage shall comply with Sections
SB2762 Enrolled -2- LRB104 16499 BAB 29895 b
1 155.22a, 355b, 356z.19, and 370c of the Illinois Insurance
2 Code. The Department of Insurance shall enforce the
3 requirements of this Section. The requirement that health
4 benefits be covered as provided in this Section is an
5 exclusive power and function of the State and is a denial and
6 limitation under Article VII, Section 6, subsection (h) of the
7 Illinois Constitution. A home rule county to which this
8 Section applies must comply with every provision of this
9 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. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
17 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff.
18 8-11-23; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718,
19 eff. 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25;
20 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff.
21 6-9-25; 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73, eff.
22 1-1-26; 104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-379,
23 eff. 1-1-26; 104-417, eff. 8-15-25; revised 1-7-26.)
24 (Text of Section after amendment by P.A. 104-446)
25 Sec. 5-1069.3. Required health benefits. If a county,
SB2762 Enrolled -3- LRB104 16499 BAB 29895 b
1 including a home rule county, is a self-insurer for purposes
2 of providing health insurance coverage for its employees, the
3 coverage shall include coverage for the post-mastectomy care
4 benefits required to be covered by a policy of accident and
5 health insurance under Section 356t and the coverage required
6 under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u,
7 356u.10, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9,
8 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
9 356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 356z.33, 356z.36,
10 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
11 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61,
12 356z.62, 356z.64, 356z.67, 356z.68, 356z.70, 356z.71, 356z.74,
13 and 356z.77, 356z.79, and 356z.80, 356z.81, 356z.82, 356z.83,
14 356z.84, 356z.85, 356z.88, and 356z.89 of the Illinois
15 Insurance Code. The coverage shall comply with Sections
16 155.22a, 355b, 356z.19, 370c, and 370c.4 of the Illinois
17 Insurance Code. The Department of Insurance shall enforce the
18 requirements of this Section. The requirement that health
19 benefits be covered as provided in this Section is an
20 exclusive power and function of the State and is a denial and
21 limitation under Article VII, Section 6, subsection (h) of the
22 Illinois Constitution. A home rule county to which this
23 Section applies must comply with every provision of this
24 Section.
25 Rulemaking authority to implement Public Act 95-1045, if
26 any, is conditioned on the rules being adopted in accordance
SB2762 Enrolled -4- LRB104 16499 BAB 29895 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. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
6 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff.
7 8-11-23; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718,
8 eff. 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25;
9 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff.
10 6-9-25; 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73, eff.
11 1-1-26; 104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-379,
12 eff. 1-1-26; 104-417, eff. 8-15-25; 104-446, eff. 6-1-26;
13 revised 1-7-26.)
14 Section 10. The Illinois Municipal Code is amended by
15 changing Section 10-4-2.3 as follows:
16 (65 ILCS 5/10-4-2.3)
17 (Text of Section before amendment by P.A. 104-446)
18 Sec. 10-4-2.3. Required health benefits. If a
19 municipality, including a home rule municipality, is a
20 self-insurer for purposes of providing health insurance
21 coverage for its employees, the coverage shall include
22 coverage for the post-mastectomy care benefits required to be
23 covered by a policy of accident and health insurance under
24 Section 356t and the coverage required under Sections 356g,
SB2762 Enrolled -5- LRB104 16499 BAB 29895 b
1 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10, 356w, 356x,
2 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
3 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
4 356z.29, 356z.30, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
5 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
6 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64,
7 356z.67, 356z.68, 356z.70, 356z.71, 356z.74, and 356z.77,
8 356z.79, and 356z.80, 356z.81, 356z.82, 356z.83, 356z.84,
9 356z.85, 356z.88, and 356z.89 of the Illinois Insurance Code.
10 The coverage shall comply with Sections 155.22a, 355b,
11 356z.19, and 370c of the Illinois Insurance Code. The
12 Department of Insurance shall enforce the requirements of this
13 Section. The requirement that health benefits be covered as
14 provided in this Section is an exclusive power and function of
15 the State and is a denial and limitation under Article VII,
16 Section 6, subsection (h) of the Illinois Constitution. A home
17 rule municipality to which this Section applies must comply
18 with every provision of this Section.
19 Rulemaking authority to implement Public Act 95-1045, if
20 any, is conditioned on the rules being adopted in accordance
21 with all provisions of the Illinois Administrative Procedure
22 Act and all rules and procedures of the Joint Committee on
23 Administrative Rules; any purported rule not so adopted, for
24 whatever reason, is unauthorized.
25 (Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
26 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff.
SB2762 Enrolled -6- LRB104 16499 BAB 29895 b
1 8-11-23; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718,
2 eff. 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25;
3 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff.
4 6-9-25; 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73, eff.
5 1-1-26; 104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-379,
6 eff. 1-1-26; 104-417, eff. 8-15-25; revised 1-8-26.)
7 (Text of Section after amendment by P.A. 104-446)
8 Sec. 10-4-2.3. Required health benefits. If a
9 municipality, including a home rule municipality, is a
10 self-insurer for purposes of providing health insurance
11 coverage for its employees, the coverage shall include
12 coverage for the post-mastectomy care benefits required to be
13 covered by a policy of accident and health insurance under
14 Section 356t and the coverage required under Sections 356g,
15 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10, 356w, 356x,
16 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
17 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
18 356z.29, 356z.30, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
19 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
20 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64,
21 356z.67, 356z.68, 356z.70, 356z.71, 356z.74, and 356z.77,
22 356z.79, and 356z.80, 356z.81, 356z.82, 356z.83, 356z.84,
23 356z.85, 356z.88, and 356z.89 of the Illinois Insurance Code.
24 The coverage shall comply with Sections 155.22a, 355b,
25 356z.19, 370c, and 370c.4 of the Illinois Insurance Code. The
SB2762 Enrolled -7- LRB104 16499 BAB 29895 b
1 Department of Insurance shall enforce the requirements of this
2 Section. The requirement that health benefits be covered as
3 provided in this Section is an exclusive power and function of
4 the State and is a denial and limitation under Article VII,
5 Section 6, subsection (h) of the Illinois Constitution. A home
6 rule municipality to which this Section applies must comply
7 with every provision of this Section.
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. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
15 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff.
16 8-11-23; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718,
17 eff. 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25;
18 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff.
19 6-9-25; 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73, eff.
20 1-1-26; 104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-379,
21 eff. 1-1-26; 104-417, eff. 8-15-25; 104-446, eff. 6-1-26;
22 revised 1-8-26.)
23 Section 15. The School Code is amended by changing Section
24 10-22.3f as follows:
SB2762 Enrolled -8- LRB104 16499 BAB 29895 b
1 (105 ILCS 5/10-22.3f)
2 (Text of Section before amendment by P.A. 104-446)
3 Sec. 10-22.3f. Required health benefits. Insurance
4 protection and benefits for employees shall provide the
5 post-mastectomy care benefits required to be covered by a
6 policy of accident and health insurance under Section 356t and
7 the coverage required under Sections 356g, 356g.5, 356g.5-1,
8 356m, 356q, 356u, 356u.10, 356w, 356x, 356z.4, 356z.4a,
9 356z.6, 356z.8, 356z.9, 356z.11, 356z.12, 356z.13, 356z.14,
10 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
11 356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
12 356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60,
13 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.70, 356z.71,
14 356z.74, and 356z.77, 356z.79, and 356z.80, 356z.81, 356z.82,
15 356z.83, 356z.84, 356z.85, 356z.88, and 356z.89 of the
16 Illinois Insurance Code. Insurance policies shall comply with
17 Section 356z.19 of the Illinois Insurance Code. The coverage
18 shall comply with Sections 155.22a, 355b, and 370c and Article
19 XXXIIB of the Illinois Insurance Code. The Department of
20 Insurance shall enforce the requirements of this Section.
21 Rulemaking authority to implement Public Act 95-1045, if
22 any, is conditioned on the rules being adopted in accordance
23 with all provisions of the Illinois Administrative Procedure
24 Act and all rules and procedures of the Joint Committee on
25 Administrative Rules; any purported rule not so adopted, for
26 whatever reason, is unauthorized.
SB2762 Enrolled -9- LRB104 16499 BAB 29895 b
1 (Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
2 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff.
3 8-11-23; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718,
4 eff. 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25;
5 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff.
6 6-9-25; 104-27, eff. 1-1-26; 104-42, eff. 8-1-25; 104-68, eff.
7 1-1-26; 104-73, eff. 1-1-26; 104-289, eff. 1-1-26; 104-324,
8 eff. 1-1-26; 104-379, eff. 1-1-26; 104-417, eff. 8-15-25;
9 revised 1-8-26.)
10 (Text of Section after amendment by P.A. 104-446)
11 Sec. 10-22.3f. Required health benefits. Insurance
12 protection and benefits for employees shall provide the
13 post-mastectomy care benefits required to be covered by a
14 policy of accident and health insurance under Section 356t and
15 the coverage required under Sections 356g, 356g.5, 356g.5-1,
16 356m, 356q, 356u, 356u.10, 356w, 356x, 356z.4, 356z.4a,
17 356z.6, 356z.8, 356z.9, 356z.11, 356z.12, 356z.13, 356z.14,
18 356z.15, 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.56, 356z.57, 356z.59, 356z.60,
21 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.70, 356z.71,
22 356z.74, and 356z.77, 356z.79, and 356z.80, 356z.81, 356z.82,
23 356z.83, 356z.84, 356z.85, 356z.88, and 356z.89 of the
24 Illinois Insurance Code. Insurance policies shall comply with
25 Section 356z.19 of the Illinois Insurance Code. The coverage
SB2762 Enrolled - 10 - LRB104 16499 BAB 29895 b
1 shall comply with Sections 155.22a, 355b, 370c, and 370c.4 and
2 Article XXXIIB of the Illinois Insurance Code. The Department
3 of Insurance shall enforce the requirements 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. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
11 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff.
12 8-11-23; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718,
13 eff. 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25;
14 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff.
15 6-9-25; 104-27, eff. 1-1-26; 104-42, eff. 8-1-25; 104-68, eff.
16 1-1-26; 104-73, eff. 1-1-26; 104-289, eff. 1-1-26; 104-324,
17 eff. 1-1-26; 104-379, eff. 1-1-26; 104-417, eff. 8-15-25;
18 104-446, eff. 6-1-26; revised 1-8-26.)
19 Section 20. The Illinois Insurance Code is amended by
20 adding Sections 356z.88 and 356z.89 as follows:
21 (215 ILCS 5/356z.88 new)
22 Sec. 356z.88. Coverage for seizure detection devices.
23 (a) For the purposes of this Section, "seizure detection
24 device" means a monitoring device cleared by the United States
SB2762 Enrolled - 11 - LRB104 16499 BAB 29895 b
1 Food and Drug Administration, and any related technology,
2 application, service, or subscription supporting the
3 prescribed use of the device, that provides the following:
4 (1) individual monitoring and alert services relating
5 to seizure activity;
6 (2) detection or prediction of seizure activity and
7 transmission of notification of the seizure activity to
8 the individual or a caregiver for appropriate medical
9 response; or
10 (3) collection of data of the seizure activity of the
11 individual that can be used by a health care provider to
12 diagnose or appropriately treat a health care condition
13 that causes the seizure activity.
14 (b) A group or individual plan of accident and health
15 insurance or managed care plan amended, delivered, issued, or
16 renewed on or after January 1, 2029 shall provide coverage for
17 medically prescribed seizure detection devices.
18 (c) All seizure detection devices covered under this
19 Section shall be approved for use by individuals, and the
20 choice of device shall be made based upon the individual's
21 circumstances and medical needs in consultation with the
22 individual's medical provider.
23 (d) Any individual who has been prescribed a seizure
24 detection device shall not be required to obtain prior
25 authorization for coverage for a seizure detection device, and
26 coverage shall be continuous once the seizure detection device
SB2762 Enrolled - 12 - LRB104 16499 BAB 29895 b
1 is prescribed.
2 (e) A group or individual policy of accident and health
3 insurance or a managed care plan that is amended, delivered,
4 issued, or renewed on or after January 1, 2029 shall not impose
5 a deductible, coinsurance, copayment, or any other
6 cost-sharing requirement of more than $50 on the coverage of a
7 seizure detection device per plan year. The provisions of this
8 subsection do not apply to coverage under this Section to the
9 extent that the coverage would disqualify a high-deductible
10 health plan from eligibility for a health savings account.
11 (215 ILCS 5/356z.89 new)
12 Sec. 356z.89. Coverage for preeclampsia biomarker testing.
13 Any group or individual policy of accident and health
14 insurance or managed care plan amended, delivered, issued, or
15 renewed on or after January 1, 2028 shall cover, without
16 imposing a deductible, coinsurance, copayment, or any other
17 cost-sharing requirement upon the insured, preeclampsia
18 biomarker testing for predictive screening in asymptomatic
19 individuals, or for diagnosis and management when symptoms are
20 present.
21 Section 25. The Health Maintenance Organization Act is
22 amended by changing Section 5-3 as follows:
23 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
SB2762 Enrolled - 13 - LRB104 16499 BAB 29895 b
1 Sec. 5-3. Illinois 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, 355.7, 355b, 355c, 356f,
7 356g, 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.76, 356z.77, 356z.78, 356z.79, 356z.80, 356z.81, 356z.82,
19 356z.83, 356z.84, 356z.85, 356z.88, 356z.89, 364, 364.01,
20 364.3, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d, 368e,
21 370a, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408, 408.2,
22 409, 412, 444, and 444.1, paragraph (c) of subsection (2) of
23 Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,
24 XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois Insurance
25 Code.
26 (b) For purposes of the Illinois Insurance Code, except
SB2762 Enrolled - 14 - LRB104 16499 BAB 29895 b
1 for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
2 Health Maintenance Organizations in the following categories
3 are deemed to be "domestic companies":
4 (1) a corporation authorized under the Dental Service
5 Plan Act or the Voluntary Health Services Plans Act;
6 (2) a corporation organized under the laws of this
7 State; or
8 (3) a corporation organized under the laws of another
9 state, 30% or more of the enrollees of which are residents
10 of this State, except a corporation subject to
11 substantially the same requirements in its state of
12 organization as is a "domestic company" under Article VIII
13 1/2 of the Illinois Insurance Code.
14 (c) In considering the merger, consolidation, or other
15 acquisition of control of a Health Maintenance Organization
16 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
17 (1) the Director shall give primary consideration to
18 the continuation of benefits to enrollees and the
19 financial conditions of the acquired Health Maintenance
20 Organization after the merger, consolidation, or other
21 acquisition of control takes effect;
22 (2)(i) the criteria specified in subsection (1)(b) of
23 Section 131.8 of the Illinois Insurance Code shall not
24 apply and (ii) the Director, in making his determination
25 with respect to the merger, consolidation, or other
26 acquisition of control, need not take into account the
SB2762 Enrolled - 15 - LRB104 16499 BAB 29895 b
1 effect on competition of the merger, consolidation, or
2 other acquisition of control;
3 (3) the Director shall have the power to require the
4 following information:
5 (A) certification by an independent actuary of the
6 adequacy of the reserves of the Health Maintenance
7 Organization sought to be acquired;
8 (B) pro forma financial statements reflecting the
9 combined balance sheets of the acquiring company and
10 the Health Maintenance Organization sought to be
11 acquired as of the end of the preceding year and as of
12 a date 90 days prior to the acquisition, as well as pro
13 forma financial statements reflecting projected
14 combined operation for a period of 2 years;
15 (C) a pro forma business plan detailing an
16 acquiring party's plans with respect to the operation
17 of the Health Maintenance Organization sought to be
18 acquired for a period of not less than 3 years; and
19 (D) such other information as the Director shall
20 require.
21 (d) The provisions of Article VIII 1/2 of the Illinois
22 Insurance Code and this Section 5-3 shall apply to the sale by
23 any health maintenance organization of greater than 10% of its
24 enrollee population (including, without limitation, the health
25 maintenance organization's right, title, and interest in and
26 to its health care certificates).
SB2762 Enrolled - 16 - LRB104 16499 BAB 29895 b
1 (e) In considering any management contract or service
2 agreement subject to Section 141.1 of the Illinois Insurance
3 Code, the Director (i) shall, in addition to the criteria
4 specified in Section 141.2 of the Illinois Insurance Code,
5 take into account the effect of the management contract or
6 service agreement on the continuation of benefits to enrollees
7 and the financial condition of the health maintenance
8 organization to be managed or serviced, and (ii) need not take
9 into account the effect of the management contract or service
10 agreement on competition.
11 (f) Except for small employer groups as defined in the
12 Small Employer Rating, Renewability and Portability Health
13 Insurance Act and except for medicare supplement policies as
14 defined in Section 363 of the Illinois Insurance Code, a
15 Health Maintenance Organization may by contract agree with a
16 group or other enrollment unit to effect refunds or charge
17 additional premiums under the following terms and conditions:
18 (i) the amount of, and other terms and conditions with
19 respect to, the refund or additional premium are set forth
20 in the group or enrollment unit contract agreed in advance
21 of the period for which a refund is to be paid or
22 additional premium is to be charged (which period shall
23 not be less than one year); and
24 (ii) the amount of the refund or additional premium
25 shall not exceed 20% of the Health Maintenance
26 Organization's profitable or unprofitable experience with
SB2762 Enrolled - 17 - LRB104 16499 BAB 29895 b
1 respect to the group or other enrollment unit for the
2 period (and, for purposes of a refund or additional
3 premium, the profitable or unprofitable experience shall
4 be calculated taking into account a pro rata share of the
5 Health Maintenance Organization's administrative and
6 marketing expenses, but shall not include any refund to be
7 made or additional premium to be paid pursuant to this
8 subsection (f)). The Health Maintenance Organization and
9 the group or enrollment unit may agree that the profitable
10 or unprofitable experience may be calculated taking into
11 account the refund period and the immediately preceding 2
12 plan years.
13 The Health Maintenance Organization shall include a
14 statement in the evidence of coverage issued to each enrollee
15 describing the possibility of a refund or additional premium,
16 and upon request of any group or enrollment unit, provide to
17 the group or enrollment unit a description of the method used
18 to calculate (1) the Health Maintenance Organization's
19 profitable experience with respect to the group or enrollment
20 unit and the resulting refund to the group or enrollment unit
21 or (2) the Health Maintenance Organization's unprofitable
22 experience with respect to the group or enrollment unit and
23 the resulting additional premium to be paid by the group or
24 enrollment unit.
25 In no event shall the Illinois Health Maintenance
26 Organization Guaranty Association be liable to pay any
SB2762 Enrolled - 18 - LRB104 16499 BAB 29895 b
1 contractual obligation of an insolvent organization to pay any
2 refund authorized under this Section.
3 (g) Rulemaking authority to implement Public Act 95-1045,
4 if any, is conditioned on the rules being adopted in
5 accordance with all provisions of the Illinois Administrative
6 Procedure Act and all rules and procedures of the Joint
7 Committee on Administrative Rules; any purported rule not so
8 adopted, for whatever reason, is unauthorized.
9 (Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
10 103-123, eff. 1-1-24; 103-154, eff. 6-30-23; 103-420, eff.
11 1-1-24; 103-426, eff. 8-4-23; 103-445, eff. 1-1-24; 103-551,
12 eff. 8-11-23; 103-605, eff. 7-1-24; 103-618, eff. 1-1-25;
13 103-649, eff. 1-1-25; 103-656, eff. 1-1-25; 103-700, eff.
14 1-1-25; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-753,
15 eff. 8-2-24; 103-758, eff. 1-1-25; 103-777, eff. 8-2-24;
16 103-808, eff. 1-1-26; 103-914, eff. 1-1-25; 103-918, eff.
17 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff. 6-9-25; 104-28,
18 eff. 1-1-26; 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73,
19 eff. 1-1-26; 104-98, eff. 1-1-26; 104-289, eff. 1-1-26;
20 104-324, eff. 1-1-26; 104-334, eff. 8-15-25; 104-379, eff.
21 1-1-26; 104-417, eff. 8-15-25; revised 11-21-25.)
22 Section 30. The Limited Health Service Organization Act is
23 amended by changing Section 4003 as follows:
24 (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
SB2762 Enrolled - 19 - LRB104 16499 BAB 29895 b
1 Sec. 4003. Illinois Insurance Code provisions. Limited
2 health service organizations shall be subject to the
3 provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
4 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151, 152, 153,
5 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 352c,
6 355.2, 355.3, 355b, 355d, 356m, 356q, 356v, 356z.4, 356z.4a,
7 356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.32,
8 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
9 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 356z.71,
10 356z.73, 356z.74, 356z.75, 356z.79, 356z.80, 356z.81, 356z.83,
11 356z.84, 356z.85, 356z.88, 356z.89, 364.3, 368a, 370a, 401,
12 401.1, 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,
14 XXVI, and XXXIIB of the Illinois Insurance Code. Nothing in
15 this Section shall require a limited health care plan to cover
16 any service that is not a limited health service. For purposes
17 of the Illinois Insurance Code, except for Sections 444 and
18 444.1 and 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
SB2762 Enrolled - 20 - LRB104 16499 BAB 29895 b
1 1/2 of the Illinois Insurance Code.
2 (Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
3 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, eff.
4 1-1-24; 103-605, eff. 7-1-24; 103-649, eff. 1-1-25; 103-656,
5 eff. 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24;
6 103-751, eff. 8-2-24; 103-758, eff. 1-1-25; 103-832, eff.
7 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff. 6-9-25; 104-42,
8 eff. 8-1-25; 104-73, eff. 1-1-26; 104-98, eff. 1-1-26;
9 104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-334, eff.
10 8-15-25; 104-379, eff. 1-1-26; 104-417, eff. 8-15-25; revised
11 11-21-25.)
12 Section 35. 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 Illinois Insurance Code
16 provisions. Health services plan corporations and all persons
17 interested therein or dealing therewith shall be subject to
18 the provisions of Articles IIA and XII 1/2 and Sections 3.1,
19 133, 136, 139, 140, 143, 143.31, 143c, 149, 155.22a, 155.37,
20 354, 355.2, 355.3, 355.7, 355b, 355d, 356g, 356g.5, 356g.5-1,
21 356m, 356q, 356r, 356t, 356u, 356u.10, 356v, 356w, 356x, 356y,
22 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
23 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
24 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26,
SB2762 Enrolled - 21 - LRB104 16499 BAB 29895 b
1 356z.29, 356z.30, 356z.32, 356z.32a, 356z.33, 356z.40,
2 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, 356z.56,
3 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64, 356z.67,
4 356z.68, 356z.71, 356z.72, 356z.74, 356z.75, 356z.77, 356z.79,
5 356z.80, 356z.81, 356z.83, 356z.84, 356z.85, 356z.88, 356z.89,
6 364.01, 364.3, 367.2, 368a, 370a, 401, 401.1, 402, 403, 403A,
7 408, 408.2, and 412, and paragraphs (7) and (15) of Section 367
8 of the Illinois Insurance Code.
9 Rulemaking authority to implement Public Act 95-1045, if
10 any, is conditioned on the rules being adopted in accordance
11 with all provisions of the Illinois Administrative Procedure
12 Act and all rules and procedures of the Joint Committee on
13 Administrative Rules; any purported rule not so adopted, for
14 whatever reason, is unauthorized.
15 (Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
16 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-551, eff.
17 8-11-23; 103-605, eff. 7-1-24; 103-656, eff. 1-1-25; 103-718,
18 eff. 7-19-24; 103-751, eff. 8-2-24; 103-753, eff. 8-2-24;
19 103-758, eff. 1-1-25; 103-832, eff. 1-1-25; 103-914, eff.
20 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1,
21 eff. 6-9-25; 104-28, eff. 1-1-26; 104-42, eff. 8-1-25; 104-73,
22 eff. 1-1-26; 104-98, eff. 1-1-26; 104-289, eff. 1-1-26;
23 104-324, eff. 1-1-26; 104-379, eff. 1-1-26; 104-417, eff.
24 8-15-25; revised 11-21-25.)
25 Section 95. No acceleration or delay. Where this Act makes
SB2762 Enrolled - 22 - LRB104 16499 BAB 29895 b
1 changes in a statute that is represented in this Act by text
2 that is not yet or no longer in effect (for example, a Section
3 represented by multiple versions), the use of that text does
4 not accelerate or delay the taking effect of (i) the changes
5 made by this Act or (ii) provisions derived from any other
6 Public Act.
7 Section 99. Effective date. This Act takes effect upon
8 becoming law.Every fact on this page links to its source, starting with the official bill record.