Bill Text: IL HB1565 | 2023-2024 | 103rd General Assembly | Enrolled

NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2024 and that provides coverage for prescription drugs shall provide coverage for vaginal estrogen, and that coverage for vaginal estrogen shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement. Makes conforming changes in the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Medical Assistance Article of the Illinois Public Aid Code.

Spectrum: Partisan Bill (Democrat 11-0)

Status: (Passed) 2023-08-04 - Public Act . . . . . . . . . 103-0420 [HB1565 Detail]

Download: Illinois-2023-HB1565-Enrolled.html



HB1565 EnrolledLRB103 25816 BMS 52167 b
1 AN ACT concerning regulation.
2 Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4 Section 5. The State Employees Group Insurance Act of 1971
5is amended by changing Section 6.11 as follows:
6 (5 ILCS 375/6.11)
7 (Text of Section before amendment by P.A. 102-768)
8 Sec. 6.11. Required health benefits; Illinois Insurance
9Code requirements. The program of health benefits shall
10provide the post-mastectomy care benefits required to be
11covered by a policy of accident and health insurance under
12Section 356t of the Illinois Insurance Code. The program of
13health benefits shall provide the coverage required under
14Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
15356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
16356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
17356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
18356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
19356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60, and
20356z.61 of the Illinois Insurance Code. The program of health
21benefits must comply with Sections 155.22a, 155.37, 355b,
22356z.19, 370c, and 370c.1 and Article XXXIIB of the Illinois
23Insurance Code. The Department of Insurance shall enforce the

HB1565 Enrolled- 2 -LRB103 25816 BMS 52167 b
1requirements of this Section with respect to Sections 370c and
2370c.1 of the Illinois Insurance Code; all other requirements
3of this Section shall be enforced by the Department of Central
4Management Services.
5 Rulemaking authority to implement Public Act 95-1045, if
6any, is conditioned on the rules being adopted in accordance
7with all provisions of the Illinois Administrative Procedure
8Act and all rules and procedures of the Joint Committee on
9Administrative Rules; any purported rule not so adopted, for
10whatever reason, is unauthorized.
11(Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20;
12101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
131-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103,
14eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
15102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
161-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
17eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
18revised 12-13-22.)
19 (Text of Section after amendment by P.A. 102-768)
20 Sec. 6.11. Required health benefits; Illinois Insurance
21Code requirements. The program of health benefits shall
22provide the post-mastectomy care benefits required to be
23covered by a policy of accident and health insurance under
24Section 356t of the Illinois Insurance Code. The program of
25health benefits shall provide the coverage required under

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1Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
2356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
3356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
4356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
5356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
6356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, and
7356z.60, and 356z.61 of the Illinois Insurance Code. The
8program of health benefits must comply with Sections 155.22a,
9155.37, 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of
10the Illinois Insurance Code. The Department of Insurance shall
11enforce the requirements of this Section with respect to
12Sections 370c and 370c.1 of the Illinois Insurance Code; all
13other requirements of this Section shall be enforced by the
14Department of Central Management Services.
15 Rulemaking authority to implement Public Act 95-1045, if
16any, is conditioned on the rules being adopted in accordance
17with all provisions of the Illinois Administrative Procedure
18Act and all rules and procedures of the Joint Committee on
19Administrative Rules; any purported rule not so adopted, for
20whatever reason, is unauthorized.
21(Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20;
22101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
231-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103,
24eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
25102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
261-1-23; 102-768, eff. 1-1-24; 102-804, eff. 1-1-23; 102-813,

HB1565 Enrolled- 4 -LRB103 25816 BMS 52167 b
1eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, eff. 1-1-23;
2102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
3 Section 10. The Counties Code is amended by changing
4Section 5-1069.3 as follows:
5 (55 ILCS 5/5-1069.3)
6 Sec. 5-1069.3. Required health benefits. If a county,
7including a home rule county, is a self-insurer for purposes
8of providing health insurance coverage for its employees, the
9coverage shall include coverage for the post-mastectomy care
10benefits required to be covered by a policy of accident and
11health insurance under Section 356t and the coverage required
12under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356w, 356x,
13356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
14356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
15356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40,
16356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53,
17356z.54, 356z.56, 356z.57, 356z.59, and 356z.60, and 356z.61
18of the Illinois Insurance Code. The coverage shall comply with
19Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
20Insurance Code. The Department of Insurance shall enforce the
21requirements of this Section. The requirement that health
22benefits be covered as provided in this Section is an
23exclusive power and function of the State and is a denial and
24limitation under Article VII, Section 6, subsection (h) of the

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1Illinois Constitution. A home rule county to which this
2Section applies must comply with every provision of this
3Section.
4 Rulemaking authority to implement Public Act 95-1045, if
5any, is conditioned on the rules being adopted in accordance
6with all provisions of the Illinois Administrative Procedure
7Act and all rules and procedures of the Joint Committee on
8Administrative Rules; any purported rule not so adopted, for
9whatever reason, is unauthorized.
10(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
11101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
121-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
13eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
14102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
151-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
16eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
17102-1117, eff. 1-13-23.)
18 Section 15. The Illinois Municipal Code is amended by
19changing Section 10-4-2.3 as follows:
20 (65 ILCS 5/10-4-2.3)
21 Sec. 10-4-2.3. Required health benefits. If a
22municipality, including a home rule municipality, is a
23self-insurer for purposes of providing health insurance
24coverage for its employees, the coverage shall include

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1coverage for the post-mastectomy care benefits required to be
2covered by a policy of accident and health insurance under
3Section 356t and the coverage required under Sections 356g,
4356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.4, 356z.4a,
5356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
6356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
7356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
8356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
9356z.56, 356z.57, 356z.59, and 356z.60, and 356z.61 of the
10Illinois Insurance Code. The coverage shall comply with
11Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
12Insurance Code. The Department of Insurance shall enforce the
13requirements of this Section. The requirement that health
14benefits be covered as provided in this is an exclusive power
15and function of the State and is a denial and limitation under
16Article VII, Section 6, subsection (h) of the Illinois
17Constitution. A home rule municipality to which this Section
18applies must comply with every provision of this Section.
19 Rulemaking authority to implement Public Act 95-1045, if
20any, is conditioned on the rules being adopted in accordance
21with all provisions of the Illinois Administrative Procedure
22Act and all rules and procedures of the Joint Committee on
23Administrative Rules; any purported rule not so adopted, for
24whatever reason, is unauthorized.
25(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
26101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.

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11-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
2eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
3102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
41-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
5eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
6102-1117, eff. 1-13-23.)
7 Section 20. The School Code is amended by changing Section
810-22.3f as follows:
9 (105 ILCS 5/10-22.3f)
10 Sec. 10-22.3f. Required health benefits. Insurance
11protection and benefits for employees shall provide the
12post-mastectomy care benefits required to be covered by a
13policy of accident and health insurance under Section 356t and
14the coverage required under Sections 356g, 356g.5, 356g.5-1,
15356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8,
16356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
17356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
18356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
19356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60, and
20356z.61 of the Illinois Insurance Code. Insurance policies
21shall comply with Section 356z.19 of the Illinois Insurance
22Code. The coverage shall comply with Sections 155.22a, 355b,
23and 370c of the Illinois Insurance Code. The Department of
24Insurance shall enforce the requirements of this Section.

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1 Rulemaking authority to implement Public Act 95-1045, if
2any, is conditioned on the rules being adopted in accordance
3with all provisions of the Illinois Administrative Procedure
4Act and all rules and procedures of the Joint Committee on
5Administrative Rules; any purported rule not so adopted, for
6whatever reason, is unauthorized.
7(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
8101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
91-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
10eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. 1-1-22;
11102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804, eff.
121-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860,
13eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
14 Section 25. The Illinois Insurance Code is amended by
15adding Section 356z.61 as follows:
16 (215 ILCS 5/356z.61 new)
17 Sec. 356z.61. Coverage of prescription estrogen.
18 (a) A group or individual policy of accident and health
19insurance or a managed care plan that is amended, delivered,
20issued, or renewed on or after January 1, 2025 and that
21provides coverage for prescription drugs shall include
22coverage for one or more therapeutic equivalent versions of
23vaginal estrogen in its formulary.
24 (b) If a particular vaginal estrogen product or its

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1therapeutic equivalent version approved by the United States
2Food and Drug Administration is determined to be medically
3necessary, the issuer must cover that service or item pursuant
4to the cost-sharing requirement contained in subsection (c).
5 (c) A policy subject to this Section shall not impose a
6deductible, copayment, or any other cost sharing requirement
7that exceeds any deductible, coinsurance, copayment, or any
8other cost-sharing requirement imposed on any prescription
9drug authorized for the treatment of erectile dysfunction
10covered by the policy; except that this subsection does not
11apply to coverage of vaginal estrogen to the extent such
12coverage would disqualify a high-deductible health plan from
13eligibility for a health savings account pursuant to Section
14223 of the Internal Revenue Code.
15 (d) As used in this Section, "therapeutic equivalent
16version" has the meaning given to that term in paragraph (2) of
17subsection (a) of Section 356z.4.
18 Section 30. The Health Maintenance Organization Act is
19amended by changing Section 5-3 as follows:
20 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
21 Sec. 5-3. Insurance Code provisions.
22 (a) Health Maintenance Organizations shall be subject to
23the provisions of Sections 133, 134, 136, 137, 139, 140,
24141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,

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1154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
2355.3, 355b, 355c, 356g.5-1, 356m, 356q, 356v, 356w, 356x,
3356y, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
4356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
5356z.15, 356z.17, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
6356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
7356z.35, 356z.36, 356z.40, 356z.41, 356z.46, 356z.47, 356z.48,
8356z.50, 356z.51, 356z.53 256z.53, 356z.54, 356z.56, 356z.57,
9356z.59, 356z.60, 356z.61, 364, 364.01, 364.3, 367.2, 367.2-5,
10367i, 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1,
11402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1,
12paragraph (c) of subsection (2) of Section 367, and Articles
13IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and
14XXXIIB of the Illinois Insurance Code.
15 (b) For purposes of the Illinois Insurance Code, except
16for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
17Health Maintenance Organizations in the following categories
18are 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

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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
4acquisition of control of a Health Maintenance Organization
5pursuant 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

HB1565 Enrolled- 12 -LRB103 25816 BMS 52167 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
11Insurance Code and this Section 5-3 shall apply to the sale by
12any health maintenance organization of greater than 10% of its
13enrollee population (including without limitation the health
14maintenance organization's right, title, and interest in and
15to its health care certificates).
16 (e) In considering any management contract or service
17agreement subject to Section 141.1 of the Illinois Insurance
18Code, the Director (i) shall, in addition to the criteria
19specified in Section 141.2 of the Illinois Insurance Code,
20take into account the effect of the management contract or
21service agreement on the continuation of benefits to enrollees
22and the financial condition of the health maintenance
23organization to be managed or serviced, and (ii) need not take
24into account the effect of the management contract or service
25agreement on competition.
26 (f) Except for small employer groups as defined in the

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1Small Employer Rating, Renewability and Portability Health
2Insurance Act and except for medicare supplement policies as
3defined in Section 363 of the Illinois Insurance Code, a
4Health Maintenance Organization may by contract agree with a
5group or other enrollment unit to effect refunds or charge
6additional 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

HB1565 Enrolled- 14 -LRB103 25816 BMS 52167 b
1 plan years.
2 The Health Maintenance Organization shall include a
3statement in the evidence of coverage issued to each enrollee
4describing the possibility of a refund or additional premium,
5and upon request of any group or enrollment unit, provide to
6the group or enrollment unit a description of the method used
7to calculate (1) the Health Maintenance Organization's
8profitable experience with respect to the group or enrollment
9unit and the resulting refund to the group or enrollment unit
10or (2) the Health Maintenance Organization's unprofitable
11experience with respect to the group or enrollment unit and
12the resulting additional premium to be paid by the group or
13enrollment unit.
14 In no event shall the Illinois Health Maintenance
15Organization Guaranty Association be liable to pay any
16contractual obligation of an insolvent organization to pay any
17refund authorized under this Section.
18 (g) Rulemaking authority to implement Public Act 95-1045,
19if any, is conditioned on the rules being adopted in
20accordance with all provisions of the Illinois Administrative
21Procedure Act and all rules and procedures of the Joint
22Committee on Administrative Rules; any purported rule not so
23adopted, for whatever reason, is unauthorized.
24(Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
25101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-393, eff.
261-1-20; 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625,

HB1565 Enrolled- 15 -LRB103 25816 BMS 52167 b
1eff. 1-1-21; 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
2102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
31-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
4eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
5102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
61-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
7eff. 1-1-23; 102-1117, eff. 1-13-23; revised 1-22-23.)
8 Section 35. The Limited Health Service Organization Act is
9amended by changing Section 4003 as follows:
10 (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
11 Sec. 4003. Illinois Insurance Code provisions. Limited
12health service organizations shall be subject to the
13provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
14141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
15154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3,
16355b, 356q, 356v, 356z.4, 356z.4a, 356z.10, 356z.21, 356z.22,
17356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
18356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, 356z.57,
19356z.59, 356z.61, 364.3, 368a, 401, 401.1, 402, 403, 403A,
20408, 408.2, 409, 412, 444, and 444.1 and Articles IIA, VIII
211/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the
22Illinois Insurance Code. Nothing in this Section shall require
23a limited health care plan to cover any service that is not a
24limited health service. For purposes of the Illinois Insurance

HB1565 Enrolled- 16 -LRB103 25816 BMS 52167 b
1Code, except for Sections 444 and 444.1 and Articles XIII and
2XIII 1/2, limited health service organizations in the
3following categories are deemed to be domestic companies:
4 (1) a corporation under the laws of this State; or
5 (2) a corporation organized under the laws of another
6 state, 30% or more of the enrollees of which are residents
7 of this State, except a corporation subject to
8 substantially the same requirements in its state of
9 organization as is a domestic company under Article VIII
10 1/2 of the Illinois Insurance Code.
11(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
12101-393, eff. 1-1-20; 101-625, eff. 1-1-21; 102-30, eff.
131-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642,
14eff. 1-1-22; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
15102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, eff.
161-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
17 Section 40. The Voluntary Health Services Plans Act is
18amended by changing Section 10 as follows:
19 (215 ILCS 165/10) (from Ch. 32, par. 604)
20 Sec. 10. Application of Insurance Code provisions. Health
21services plan corporations and all persons interested therein
22or dealing therewith shall be subject to the provisions of
23Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
24143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,

HB1565 Enrolled- 17 -LRB103 25816 BMS 52167 b
1356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w,
2356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5,
3356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
4356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
5356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
6356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
7356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 364.01, 364.3,
8367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
9and paragraphs (7) and (15) of Section 367 of the Illinois
10Insurance Code.
11 Rulemaking authority to implement Public Act 95-1045, if
12any, is conditioned on the rules being adopted in accordance
13with all provisions of the Illinois Administrative Procedure
14Act and all rules and procedures of the Joint Committee on
15Administrative Rules; any purported rule not so adopted, for
16whatever reason, is unauthorized.
17(Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
18101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff.
191-1-21; 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 102-306,
20eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21;
21102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804, eff.
221-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860,
23eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff. 1-1-23;
24102-1117, eff. 1-13-23.)
25 Section 45. The Illinois Public Aid Code is amended by

HB1565 Enrolled- 18 -LRB103 25816 BMS 52167 b
1changing Section 5-16.8 as follows:
2 (305 ILCS 5/5-16.8)
3 Sec. 5-16.8. Required health benefits. The medical
4assistance program shall (i) provide the post-mastectomy care
5benefits required to be covered by a policy of accident and
6health insurance under Section 356t and the coverage required
7under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
8356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
9356z.47, 356z.51, 356z.53, 356z.56, 356z.59, and 356z.60, and
10356z.61 of the Illinois Insurance Code, (ii) be subject to the
11provisions of Sections 356z.19, 356z.44, 356z.49, 364.01,
12370c, and 370c.1 of the Illinois Insurance Code, and (iii) be
13subject to the provisions of subsection (d-5) of Section 10 of
14the Network Adequacy and Transparency Act.
15 The Department, by rule, shall adopt a model similar to
16the requirements of Section 356z.39 of the Illinois Insurance
17Code.
18 On and after July 1, 2012, the Department shall reduce any
19rate of reimbursement for services or other payments or alter
20any methodologies authorized by this Code to reduce any rate
21of reimbursement for services or other payments in accordance
22with Section 5-5e.
23 To ensure full access to the benefits set forth in this
24Section, on and after January 1, 2016, the Department shall
25ensure that provider and hospital reimbursement for

HB1565 Enrolled- 19 -LRB103 25816 BMS 52167 b
1post-mastectomy care benefits required under this Section are
2no lower than the Medicare reimbursement rate.
3(Source: P.A. 101-81, eff. 7-12-19; 101-218, eff. 1-1-20;
4101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-574, eff.
51-1-20; 101-649, eff. 7-7-20; 102-30, eff. 1-1-22; 102-144,
6eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
7102-530, eff. 1-1-22; 102-642, eff. 1-1-22; 102-804, eff.
81-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093,
9eff. 1-1-23; 102-1117, eff. 1-13-23.)
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