Bill Text: IL HB5493 | 2023-2024 | 103rd General Assembly | Engrossed

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Bill Title: Reinserts the provisions of the introduced bill with the following changes. Further amends the Illinois Insurance Code. Repeals a provision requiring certain policies to offer, for an additional premium and subject to the insurer's standard of insurability, optional coverage or optional reimbursement for hearing instruments and related services for all individuals when a hearing care professional prescribes a hearing instrument to augment communication. Makes conforming changes. In a provision concerning the scope of the Casualty Insurance, Fidelity Bonds and Surety Contracts Article, includes certain policies that are not otherwise excluded under the Unauthorized Companies Article. Removes changes to a provision concerning fraud reporting. Further amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, and the School Code. Requires coverage or reimbursement for hearing aids. Makes other changes. Amends the Voluntary Health Services Plans Act to make a conforming change. Effective immediately, except that certain provisions are effective January 1, 2025.

Spectrum: Partisan Bill (Democrat 3-0)

Status: (Engrossed) 2024-04-24 - Referred to Assignments [HB5493 Detail]

Download: Illinois-2023-HB5493-Engrossed.html

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HB5493 Engrossed LRB103 39189 RPS 69335 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The State Employees Group Insurance Act of 1971
is amended by changing Sections 6.7 and 6.11 as follows:
(5 ILCS 375/6.7)
Sec. 6.7. Access to obstetrical and gynecological care
Woman's health care provider. The program of health benefits
is subject to the provisions of Section 356r of the Illinois
Insurance Code.
(Source: P.A. 89-514, eff. 7-17-96; 90-14, eff. 7-1-97.)
(5 ILCS 375/6.11)
Sec. 6.11. Required health benefits; Illinois Insurance
Code requirements. The program of health benefits shall
provide the post-mastectomy care benefits required to be
covered by a policy of accident and health insurance under
Section 356t of the Illinois Insurance Code. The program of
health benefits shall provide the coverage required under
Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32,

HB5493 Engrossed - 2 - LRB103 39189 RPS 69335 b
356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59,
356z.60, and 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68,
and 356z.70 of the Illinois Insurance Code. The program of
health benefits must comply with Sections 155.22a, 155.37,
355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of the
Illinois Insurance Code. The program of health benefits shall
provide the coverage required under Section 356m of the
Illinois Insurance Code and, for the employees of the State
Employee Group Insurance Program only, the coverage as also
provided in Section 6.11B of this Act. The Department of
Insurance shall enforce the requirements of this Section with
respect to Sections 370c and 370c.1 of the Illinois Insurance
Code; all other requirements of this Section shall be enforced
by the Department of Central Management Services.
Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768,
eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.

HB5493 Engrossed - 3 - LRB103 39189 RPS 69335 b
1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84,
eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24;
103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff.
8-11-23; revised 8-29-23.)
Section 10. The Counties Code is amended by changing
Sections 5-1069.3 and 5-1069.5 as follows:
(55 ILCS 5/5-1069.3)
Sec. 5-1069.3. Required health benefits. If a county,
including a home rule county, is a self-insurer for purposes
of providing health insurance coverage for its employees, the
coverage shall include coverage for the post-mastectomy care
benefits required to be covered by a policy of accident and
health insurance under Section 356t and the coverage required
under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356w, 356x,
356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, 356z.36,
356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and
356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70
of the Illinois Insurance Code. The coverage shall comply with
Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
Insurance Code. The Department of Insurance shall enforce the
requirements of this Section. The requirement that health

HB5493 Engrossed - 4 - LRB103 39189 RPS 69335 b
benefits be covered as provided in this Section is an
exclusive power and function of the State and is a denial and
limitation under Article VII, Section 6, subsection (h) of the
Illinois Constitution. A home rule county to which this
Section applies must comply with every provision of this
Section.
Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
8-29-23.)
(55 ILCS 5/5-1069.5)
Sec. 5-1069.5. Access to obstetrical and gynecological
care Woman's health care provider. All counties, including
home rule counties, are subject to the provisions of Section

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356r of the Illinois Insurance Code. The requirement under
this Section that health care benefits provided by counties
comply with Section 356r of the Illinois Insurance Code is an
exclusive power and function of the State and is a denial and
limitation of home rule county powers under Article VII,
Section 6, subsection (h) of the Illinois Constitution.
(Source: P.A. 89-514, eff. 7-17-96; 90-14, eff. 7-1-97.)
Section 15. The Illinois Municipal Code is amended by
changing Sections 10-4-2.3 and 10-4-2.5 as follows:
(65 ILCS 5/10-4-2.3)
Sec. 10-4-2.3. Required health benefits. If a
municipality, including a home rule municipality, is a
self-insurer for purposes of providing health insurance
coverage for its employees, the coverage shall include
coverage for the post-mastectomy care benefits required to be
covered by a policy of accident and health insurance under
Section 356t and the coverage required under Sections 356g,
356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.4, 356z.4a,
356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and 356z.62,
356z.64, 356z.67, 356z.68, and 356z.70 of the Illinois

HB5493 Engrossed - 6 - LRB103 39189 RPS 69335 b
Insurance Code. The coverage shall comply with Sections
155.22a, 355b, 356z.19, and 370c of the Illinois Insurance
Code. The Department of Insurance shall enforce the
requirements of this Section. The requirement that health
benefits be covered as provided in this is an exclusive power
and function of the State and is a denial and limitation under
Article VII, Section 6, subsection (h) of the Illinois
Constitution. A home rule municipality to which this Section
applies must comply with every provision of this Section.
Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
8-29-23.)
(65 ILCS 5/10-4-2.5)

HB5493 Engrossed - 7 - LRB103 39189 RPS 69335 b
Sec. 10-4-2.5. Access to obstetrical and gynecological
care Woman's health care provider. The corporate authorities
of all municipalities are subject to the provisions of Section
356r of the Illinois Insurance Code. The requirement under
this Section that health care benefits provided by
municipalities comply with Section 356r of the Illinois
Insurance Code is an exclusive power and function of the State
and is a denial and limitation of home rule municipality
powers under Article VII, Section 6, subsection (h) of the
Illinois Constitution.
(Source: P.A. 89-514, eff. 7-17-96; 90-14, eff. 7-1-97.)
Section 20. The School Code is amended by changing
Sections 10-22.3d and 10-22.3f as follows:
(105 ILCS 5/10-22.3d)
Sec. 10-22.3d. Access to obstetrical and gynecological
care Woman's health care provider. Insurance protection and
benefits for employees are subject to the provisions of
Section 356r of the Illinois Insurance Code.
(Source: P.A. 89-514, eff. 7-17-96; 90-14, eff. 7-1-97.)
(105 ILCS 5/10-22.3f)
Sec. 10-22.3f. Required health benefits. Insurance
protection and benefits for employees shall provide the
post-mastectomy care benefits required to be covered by a

HB5493 Engrossed - 8 - LRB103 39189 RPS 69335 b
policy of accident and health insurance under Section 356t and
the coverage required under Sections 356g, 356g.5, 356g.5-1,
356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8,
356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32,
356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60,
and 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, and
356z.70 of the Illinois Insurance Code. Insurance policies
shall comply with Section 356z.19 of the Illinois Insurance
Code. The coverage shall comply with Sections 155.22a, 355b,
and 370c of the Illinois Insurance Code. The Department of
Insurance shall enforce the requirements of this Section.
Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,
eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.
1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,
eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;

HB5493 Engrossed - 9 - LRB103 39189 RPS 69335 b
103-551, eff. 8-11-23; revised 8-29-23.)
Section 25. The Illinois Insurance Code is amended by
changing Sections 4, 352, 352b, 356a, 356b, 356d, 356e, 356f,
356K, 356L, 356r, 356s, 356z.3, 356z.33, 367a, 370e, 370i,
408, 412, and 531.03 as follows:
(215 ILCS 5/4) (from Ch. 73, par. 616)
Sec. 4. Classes of insurance. Insurance and insurance
business shall be classified as follows:
Class 1. Life, Accident and Health.
(a) Life. Insurance on the lives of persons and every
insurance appertaining thereto or connected therewith and
granting, purchasing or disposing of annuities. Policies of
life or endowment insurance or annuity contracts or contracts
supplemental thereto which contain provisions for additional
benefits in case of death by accidental means and provisions
operating to safeguard such policies or contracts against
lapse, to give a special surrender value, or special benefit,
or an annuity, in the event, that the insured or annuitant
shall become a person with a total and permanent disability as
defined by the policy or contract, or which contain benefits
providing acceleration of life or endowment or annuity
benefits in advance of the time they would otherwise be
payable, as an indemnity for long term care which is certified
or ordered by a physician, including but not limited to,

HB5493 Engrossed - 10 - LRB103 39189 RPS 69335 b
professional nursing care, medical care expenses, custodial
nursing care, non-nursing custodial care provided in a nursing
home or at a residence of the insured, or which contain
benefits providing acceleration of life or endowment or
annuity benefits in advance of the time they would otherwise
be payable, at any time during the insured's lifetime, as an
indemnity for a terminal illness shall be deemed to be
policies of life or endowment insurance or annuity contracts
within the intent of this clause.
Also to be deemed as policies of life or endowment
insurance or annuity contracts within the intent of this
clause shall be those policies or riders that provide for the
payment of up to 75% of the face amount of benefits in advance
of the time they would otherwise be payable upon a diagnosis by
a physician licensed to practice medicine in all of its
branches that the insured has incurred a covered condition
listed in the policy or rider.
"Covered condition", as used in this clause, means: heart
attack, stroke, coronary artery surgery, life-threatening life
threatening cancer, renal failure, Alzheimer's disease,
paraplegia, major organ transplantation, total and permanent
disability, and any other medical condition that the
Department may approve for any particular filing.
The Director may issue rules that specify prohibited
policy provisions, not otherwise specifically prohibited by
law, which in the opinion of the Director are unjust, unfair,

HB5493 Engrossed - 11 - LRB103 39189 RPS 69335 b
or unfairly discriminatory to the policyholder, any person
insured under the policy, or beneficiary.
(b) Accident and health. Insurance against bodily injury,
disablement or death by accident and against disablement
resulting from sickness or old age and every insurance
appertaining thereto, including stop-loss insurance. In this
clause, "stop-loss Stop-loss insurance" means is insurance
against the risk of economic loss issued to or for the benefit
of a single employer self-funded employee disability benefit
plan or an employee welfare benefit plan as described in 29
U.S.C. 1001 100 et seq., where (i) the policy is issued to and
insures an employer, trustee, or other sponsor of the plan, or
the plan itself, but not employees, members, or participants;
and (ii) payments by the insurer are made to the employer,
trustee, or other sponsors of the plan, or the plan itself, but
not to the employees, members, participants, or health care
providers. The insurance laws of this State, including this
Code, do not apply to arrangements between a religious
organization and the organization's members or participants
when the arrangement and organization meet all of the
following criteria:
(i) the organization is described in Section 501(c)(3)
of the Internal Revenue Code and is exempt from taxation
under Section 501(a) of the Internal Revenue Code;
(ii) members of the organization share a common set of
ethical or religious beliefs and share medical expenses

HB5493 Engrossed - 12 - LRB103 39189 RPS 69335 b
among members in accordance with those beliefs and without
regard to the state in which a member resides or is
employed;
(iii) no funds that have been given for the purpose of
the sharing of medical expenses among members described in
paragraph (ii) of this subsection (b) are held by the
organization in an off-shore trust or bank account;
(iv) the organization provides at least monthly to all
of its members a written statement listing the dollar
amount of qualified medical expenses that members have
submitted for sharing, as well as the amount of expenses
actually shared among the members;
(v) members of the organization retain membership even
after they develop a medical condition;
(vi) the organization or a predecessor organization
has been in existence at all times since December 31,
1999, and medical expenses of its members have been shared
continuously and without interruption since at least
December 31, 1999;
(vii) the organization conducts an annual audit that
is performed by an independent certified public accounting
firm in accordance with generally accepted accounting
principles and is made available to the public upon
request;
(viii) the organization includes the following
statement, in writing, on or accompanying all applications

HB5493 Engrossed - 13 - LRB103 39189 RPS 69335 b
and guideline materials:
"Notice: The organization facilitating the sharing of
medical expenses is not an insurance company, and
neither its guidelines nor plan of operation
constitute or create an insurance policy. Any
assistance you receive with your medical bills will be
totally voluntary. As such, participation in the
organization or a subscription to any of its documents
should never be considered to be insurance. Whether or
not you receive any payments for medical expenses and
whether or not this organization continues to operate,
you are always personally responsible for the payment
of your own medical bills.";
(ix) any membership card or similar document issued by
the organization and any written communication sent by the
organization to a hospital, physician, or other health
care provider shall include a statement that the
organization does not issue health insurance and that the
member or participant is personally liable for payment of
his or her medical bills;
(x) the organization provides to a participant, within
30 days after the participant joins, a complete set of its
rules for the sharing of medical expenses, appeals of
decisions made by the organization, and the filing of
complaints;
(xi) the organization does not offer any other

HB5493 Engrossed - 14 - LRB103 39189 RPS 69335 b
services that are regulated under any provision of the
Illinois Insurance Code or other insurance laws of this
State; and
(xii) the organization does not amass funds as
reserves intended for payment of medical services, rather
the organization facilitates the payments provided for in
this subsection (b) through payments made directly from
one participant to another.
(c) Legal Expense Insurance. Insurance which involves the
assumption of a contractual obligation to reimburse the
beneficiary against or pay on behalf of the beneficiary, all
or a portion of his fees, costs, or expenses related to or
arising out of services performed by or under the supervision
of an attorney licensed to practice in the jurisdiction
wherein the services are performed, regardless of whether the
payment is made by the beneficiaries individually or by a
third person for them, but does not include the provision of or
reimbursement for legal services incidental to other insurance
coverages. The insurance laws of this State, including this
Act do not apply to:
(i) retainer contracts made by attorneys at law with
individual clients with fees based on estimates of the
nature and amount of services to be provided to the
specific client, and similar contracts made with a group
of clients involved in the same or closely related legal
matters;

HB5493 Engrossed - 15 - LRB103 39189 RPS 69335 b
(ii) plans owned or operated by attorneys who are the
providers of legal services to the plan;
(iii) plans providing legal service benefits to groups
where such plans are owned or operated by authority of a
state, county, local or other bar association;
(iv) any lawyer referral service authorized or
operated by a state, county, local or other bar
association;
(v) the furnishing of legal assistance by labor unions
and other employee organizations to their members in
matters relating to employment or occupation;
(vi) the furnishing of legal assistance to members or
dependents, by churches, consumer organizations,
cooperatives, educational institutions, credit unions, or
organizations of employees, where such organizations
contract directly with lawyers or law firms for the
provision of legal services, and the administration and
marketing of such legal services is wholly conducted by
the organization or its subsidiary;
(vii) legal services provided by an employee welfare
benefit plan defined by the Employee Retirement Income
Security Act of 1974;
(viii) any collectively bargained plan for legal
services between a labor union and an employer negotiated
pursuant to Section 302 of the Labor Management Relations
Act as now or hereafter amended, under which plan legal

HB5493 Engrossed - 16 - LRB103 39189 RPS 69335 b
services will be provided for employees of the employer
whether or not payments for such services are funded to or
through an insurance company.
Class 2. Casualty, Fidelity and Surety.
(a) Accident and health. Insurance against bodily injury,
disablement or death by accident and against disablement
resulting from sickness or old age and every insurance
appertaining thereto, including stop-loss insurance. In this
clause, "stop-loss Stop-loss insurance" has meaning given to
that term in clause (b) of Class 1 is insurance against the
risk of economic loss issued to a single employer self-funded
employee disability benefit plan or an employee welfare
benefit plan as described in 29 U.S.C. 1001 et seq.
(b) Vehicle. Insurance against any loss or liability
resulting from or incident to the ownership, maintenance or
use of any vehicle (motor or otherwise), draft animal or
aircraft. Any policy insuring against any loss or liability on
account of the bodily injury or death of any person may contain
a provision for payment of disability benefits to injured
persons and death benefits to dependents, beneficiaries or
personal representatives of persons who are killed, including
the named insured, irrespective of legal liability of the
insured, if the injury or death for which benefits are
provided is caused by accident and sustained while in or upon
or while entering into or alighting from or through being
struck by a vehicle (motor or otherwise), draft animal or

HB5493 Engrossed - 17 - LRB103 39189 RPS 69335 b
aircraft, and such provision shall not be deemed to be
accident insurance.
(c) Liability. Insurance against the liability of the
insured for the death, injury or disability of an employee or
other person, and insurance against the liability of the
insured for damage to or destruction of another person's
property.
(d) Workers' compensation. Insurance of the obligations
accepted by or imposed upon employers under laws for workers'
compensation.
(e) Burglary and forgery. Insurance against loss or damage
by burglary, theft, larceny, robbery, forgery, fraud or
otherwise; including all householders' personal property
floater risks.
(f) Glass. Insurance against loss or damage to glass
including lettering, ornamentation and fittings from any
cause.
(g) Fidelity and surety. Become surety or guarantor for
any person, copartnership or corporation in any position or
place of trust or as custodian of money or property, public or
private; or, becoming a surety or guarantor for the
performance of any person, copartnership or corporation of any
lawful obligation, undertaking, agreement or contract of any
kind, except contracts or policies of insurance; and
underwriting blanket bonds. Such obligations shall be known
and treated as suretyship obligations and such business shall

HB5493 Engrossed - 18 - LRB103 39189 RPS 69335 b
be known as surety business.
(h) Miscellaneous. Insurance against loss or damage to
property and any liability of the insured caused by accidents
to boilers, pipes, pressure containers, machinery and
apparatus of any kind and any apparatus connected thereto, or
used for creating, transmitting or applying power, light,
heat, steam or refrigeration, making inspection of and issuing
certificates of inspection upon elevators, boilers, machinery
and apparatus of any kind and all mechanical apparatus and
appliances appertaining thereto; insurance against loss or
damage by water entering through leaks or openings in
buildings, or from the breakage or leakage of a sprinkler,
pumps, water pipes, plumbing and all tanks, apparatus,
conduits and containers designed to bring water into buildings
or for its storage or utilization therein, or caused by the
falling of a tank, tank platform or supports, or against loss
or damage from any cause (other than causes specifically
enumerated under Class 3 of this Section) to such sprinkler,
pumps, water pipes, plumbing, tanks, apparatus, conduits or
containers; insurance against loss or damage which may result
from the failure of debtors to pay their obligations to the
insured; and insurance of the payment of money for personal
services under contracts of hiring.
(i) Other casualty risks. Insurance against any other
casualty risk not otherwise specified under Classes 1 or 3,
which may lawfully be the subject of insurance and may

HB5493 Engrossed - 19 - LRB103 39189 RPS 69335 b
properly be classified under Class 2.
(j) Contingent losses. Contingent, consequential and
indirect coverages wherein the proximate cause of the loss is
attributable to any one of the causes enumerated under Class
2. Such coverages shall, for the purpose of classification, be
included in the specific grouping of the kinds of insurance
wherein such cause is specified.
(k) Livestock and domestic animals. Insurance against
mortality, accident and health of livestock and domestic
animals.
(l) Legal expense insurance. Insurance against risk
resulting from the cost of legal services as defined under
Class 1(c).
Class 3. Fire and Marine, etc.
(a) Fire. Insurance against loss or damage by fire, smoke
and smudge, lightning or other electrical disturbances.
(b) Elements. Insurance against loss or damage by
earthquake, windstorms, cyclone, tornado, tempests, hail,
frost, snow, ice, sleet, flood, rain, drought or other weather
or climatic conditions including excess or deficiency of
moisture, rising of the waters of the ocean or its
tributaries.
(c) War, riot and explosion. Insurance against loss or
damage by bombardment, invasion, insurrection, riot, strikes,
civil war or commotion, military or usurped power, or
explosion (other than explosion of steam boilers and the

HB5493 Engrossed - 20 - LRB103 39189 RPS 69335 b
breaking of fly wheels on premises owned, controlled, managed,
or maintained by the insured).
(d) Marine and transportation. Insurance against loss or
damage to vessels, craft, aircraft, vehicles of every kind,
(excluding vehicles operating under their own power or while
in storage not incidental to transportation) as well as all
goods, freights, cargoes, merchandise, effects, disbursements,
profits, moneys, bullion, precious stones, securities, choses
in action, evidences of debt, valuable papers, bottomry and
respondentia interests and all other kinds of property and
interests therein, in respect to, appertaining to or in
connection with any or all risks or perils of navigation,
transit, or transportation, including war risks, on or under
any seas or other waters, on land or in the air, or while being
assembled, packed, crated, baled, compressed or similarly
prepared for shipment or while awaiting the same or during any
delays, storage, transshipment, or reshipment incident
thereto, including marine builder's risks and all personal
property floater risks; and for loss or damage to persons or
property in connection with or appertaining to marine, inland
marine, transit or transportation insurance, including
liability for loss of or damage to either arising out of or in
connection with the construction, repair, operation,
maintenance, or use of the subject matter of such insurance,
(but not including life insurance or surety bonds); but,
except as herein specified, shall not mean insurances against

HB5493 Engrossed - 21 - LRB103 39189 RPS 69335 b
loss by reason of bodily injury to the person; and insurance
against loss or damage to precious stones, jewels, jewelry,
gold, silver and other precious metals whether used in
business or trade or otherwise and whether the same be in
course of transportation or otherwise, which shall include
jewelers' block insurance; and insurance against loss or
damage to bridges, tunnels and other instrumentalities of
transportation and communication (excluding buildings, their
furniture and furnishings, fixed contents and supplies held in
storage) unless fire, tornado, sprinkler leakage, hail,
explosion, earthquake, riot and civil commotion are the only
hazards to be covered; and to piers, wharves, docks and slips,
excluding the risks of fire, tornado, sprinkler leakage, hail,
explosion, earthquake, riot and civil commotion; and to other
aids to navigation and transportation, including dry docks and
marine railways, against all risk.
(e) Vehicle. Insurance against loss or liability resulting
from or incident to the ownership, maintenance or use of any
vehicle (motor or otherwise), draft animal or aircraft,
excluding the liability of the insured for the death, injury
or disability of another person.
(f) Property damage, sprinkler leakage and crop. Insurance
against the liability of the insured for loss or damage to
another person's property or property interests from any cause
enumerated in this class; insurance against loss or damage by
water entering through leaks or openings in buildings, or from

HB5493 Engrossed - 22 - LRB103 39189 RPS 69335 b
the breakage or leakage of a sprinkler, pumps, water pipes,
plumbing and all tanks, apparatus, conduits and containers
designed to bring water into buildings or for its storage or
utilization therein, or caused by the falling of a tank, tank
platform or supports or against loss or damage from any cause
to such sprinklers, pumps, water pipes, plumbing, tanks,
apparatus, conduits or containers; insurance against loss or
damage from insects, diseases or other causes to trees, crops
or other products of the soil.
(g) Other fire and marine risks. Insurance against any
other property risk not otherwise specified under Classes 1 or
2, which may lawfully be the subject of insurance and may
properly be classified under Class 3.
(h) Contingent losses. Contingent, consequential and
indirect coverages wherein the proximate cause of the loss is
attributable to any of the causes enumerated under Class 3.
Such coverages shall, for the purpose of classification, be
included in the specific grouping of the kinds of insurance
wherein such cause is specified.
(i) Legal expense insurance. Insurance against risk
resulting from the cost of legal services as defined under
Class 1(c).
(Source: P.A. 101-81, eff. 7-12-19.)
(215 ILCS 5/352) (from Ch. 73, par. 964)
Sec. 352. Scope of Article.

HB5493 Engrossed - 23 - LRB103 39189 RPS 69335 b
(a) Except as provided in subsections (b), (c), (d), and
(e), and (g), this Article shall apply to all companies
transacting in this State the kinds of business enumerated in
clause (b) of Class 1 and clause (a) of Class 2 of Section 4
and to all policies, contracts, and certificates of insurance
issued in connection therewith that are not otherwise excluded
under Article VII of this Code. Nothing in this Article shall
apply to, or in any way affect policies or contracts described
in clause (a) of Class 1 of Section 4; however, this Article
shall apply to policies and contracts which contain benefits
providing reimbursement for the expenses of long term health
care which are certified or ordered by a physician including
but not limited to professional nursing care, custodial
nursing care, and non-nursing custodial care provided in a
nursing home or at a residence of the insured.
(b) (Blank).
(c) A policy issued and delivered in this State that
provides coverage under that policy for certificate holders
who are neither residents of nor employed in this State does
not need to provide to those nonresident certificate holders
who are not employed in this State the coverages or services
mandated by this Article.
(d) Stop-loss insurance, as defined in clause (b) of Class
1 or clause (a) of Class 2 of Section 4, is exempt from all
Sections of this Article, except this Section and Sections
353a, 354, 357.30, and 370. For purposes of this exemption,

HB5493 Engrossed - 24 - LRB103 39189 RPS 69335 b
stop-loss insurance is further defined as follows:
(1) The policy must be issued to and insure an
employer, trustee, or other sponsor of the plan, or the
plan itself, but not employees, members, or participants.
(2) Payments by the insurer must be made to the
employer, trustee, or other sponsors of the plan, or the
plan itself, but not to the employees, members,
participants, or health care providers.
(e) A policy issued or delivered in this State to the
Department of Healthcare and Family Services (formerly
Illinois Department of Public Aid) and providing coverage,
under clause (b) of Class 1 or clause (a) of Class 2 as
described in Section 4, to persons who are enrolled under
Article V of the Illinois Public Aid Code or under the
Children's Health Insurance Program Act is exempt from all
restrictions, limitations, standards, rules, or regulations
respecting benefits imposed by or under authority of this
Code, except those specified by subsection (1) of Section 143,
Section 370c, and Section 370c.1. Nothing in this subsection,
however, affects the total medical services available to
persons eligible for medical assistance under the Illinois
Public Aid Code.
(f) An in-office membership care agreement provided under
the In-Office Membership Care Act is not insurance for the
purposes of this Code.
(g) The provisions of Sections 356a through 359a, both

HB5493 Engrossed - 25 - LRB103 39189 RPS 69335 b
inclusive, shall not apply to or affect:
(1) any policy or contract of reinsurance; or
(2) life insurance, endowment or annuity contracts, or
contracts supplemental thereto that contain only such
provisions relating to accident and sickness insurance
that (A) provide additional benefits in case of death or
dismemberment or loss of sight by accident, or (B) operate
to safeguard such contracts against lapse, or to give a
special surrender value or special benefit or an annuity
if the insured or annuitant becomes a person with a total
and permanent disability, as defined by the contract or
supplemental contract.
(Source: P.A. 101-190, eff. 8-2-19.)
(215 ILCS 5/352b)
Sec. 352b. Excepted benefits exempted Policy of individual
or group accident and health insurance.
(a) Unless specified otherwise and when used in context of
accident and health insurance policy benefits, coverage,
terms, or conditions required to be provided under this
Article, references to any "policy of individual or group
accident and health insurance", or both, as used in this
Article, do does not include any coverage or policy that
provides an excepted benefit, as that term is defined in
Section 2791(c) of the federal Public Health Service Act (42
U.S.C. 300gg-91). Nothing in this subsection amendatory Act of

HB5493 Engrossed - 26 - LRB103 39189 RPS 69335 b
the 101st General Assembly applies to a policy of liability,
workers' compensation, automobile medical payment, or limited
scope dental or vision benefits insurance issued under this
Code. Nothing in this subsection shall be construed to subject
excepted benefits outside the scope of Section 352 to any
requirements of this Article.
(b) Nothing in this Article shall require a policy of
excepted benefits to provide benefits, coverage, terms, or
conditions in such a manner as to disqualify it from being
classified under federal law as the type of excepted benefit
for which its policy forms are filed under Sections 143 and 355
of this Code.
(Source: P.A. 101-456, eff. 8-23-19.)
(215 ILCS 5/356a) (from Ch. 73, par. 968a)
Sec. 356a. Form of policy.
(1) No individual policy of accident and health insurance
shall be delivered or issued for delivery to any person in this
State state unless:
(a) the entire money and other considerations therefor
are expressed therein; and
(b) the time at which the insurance takes effect and
terminates is expressed therein; and
(c) it purports to insure only one person, except that
a policy may insure, originally or by subsequent
amendment, upon the application of an adult member of a

HB5493 Engrossed - 27 - LRB103 39189 RPS 69335 b
family who shall be deemed the policyholder, any 2 two or
more eligible members of that family, including husband,
wife, dependent children or any children under a specified
age which shall not exceed 19 years and any other person
dependent upon the policyholder; and
(d) the style, arrangement and over-all appearance of
the policy give no undue prominence to any portion of the
text, and unless every printed portion of the text of the
policy and of any endorsements or attached papers is
plainly printed in light-faced type of a style in general
use, the size of which shall be uniform and not less than
ten-point with a lower-case unspaced alphabet length not
less than one hundred and twenty-point (the "text" shall
include all printed matter except the name and address of
the insurer, name or title of the policy, the brief
description if any, and captions and subcaptions); and
(e) the exceptions and reductions of indemnity are set
forth in the policy and, except those which are set forth
in Sections 357.1 through 357.30 of this act, are printed,
at the insurer's option, either included with the benefit
provision to which they apply, or under an appropriate
caption such as "EXCEPTIONS", or "EXCEPTIONS AND
REDUCTIONS", provided that if an exception or reduction
specifically applies only to a particular benefit of the
policy, a statement of such exception or reduction shall
be included with the benefit provision to which it

HB5493 Engrossed - 28 - LRB103 39189 RPS 69335 b
applies; and
(f) each such form, including riders and endorsements,
shall be identified by a form number in the lower
left-hand corner of the first page thereof; and
(g) it contains no provision purporting to make any
portion of the charter, rules, constitution, or by-laws of
the insurer a part of the policy unless such portion is set
forth in full in the policy, except in the case of the
incorporation of, or reference to, a statement of rates or
classification of risks, or short-rate table filed with
the Director.
(2) If any policy is issued by an insurer domiciled in this
state for delivery to a person residing in another state, and
if the official having responsibility for the administration
of the insurance laws of such other state shall have advised
the Director that any such policy is not subject to approval or
disapproval by such official, the Director may by ruling
require that such policy meet the standards set forth in
subsection (1) of this section and in Sections 357.1 through
357.30.
(Source: P.A. 76-860.)
(215 ILCS 5/356b) (from Ch. 73, par. 968b)
Sec. 356b. (a) This Section applies to the hospital and
medical expense provisions of an individual accident or health
insurance policy.

HB5493 Engrossed - 29 - LRB103 39189 RPS 69335 b
(b) If a policy provides that coverage of a dependent
person terminates upon attainment of the limiting age for
dependent persons specified in the policy, the attainment of
such limiting age does not operate to terminate the hospital
and medical coverage of a person who, because of a disabling
condition that occurred before attainment of the limiting age,
is incapable of self-sustaining employment and is dependent on
his or her parents or other care providers for lifetime care
and supervision.
(c) For purposes of subsection (b), "dependent on other
care providers" is defined as requiring a Community Integrated
Living Arrangement, group home, supervised apartment, or other
residential services licensed or certified by the Department
of Human Services (as successor to the Department of Mental
Health and Developmental Disabilities), the Department of
Public Health, or the Department of Healthcare and Family
Services (formerly Department of Public Aid).
(d) The insurer may inquire of the policyholder 2 months
prior to attainment by a dependent of the limiting age set
forth in the policy, or at any reasonable time thereafter,
whether such dependent is in fact a person who has a disability
and is dependent and, in the absence of proof submitted within
60 days of such inquiry that such dependent is a person who has
a disability and is dependent may terminate coverage of such
person at or after attainment of the limiting age. In the
absence of such inquiry, coverage of any person who has a

HB5493 Engrossed - 30 - LRB103 39189 RPS 69335 b
disability and is dependent shall continue through the term of
such policy or any extension or renewal thereof.
(e) This amendatory Act of 1969 is applicable to policies
issued or renewed more than 60 days after the effective date of
this amendatory Act of 1969.
(Source: P.A. 99-143, eff. 7-27-15.)
(215 ILCS 5/356d) (from Ch. 73, par. 968d)
Sec. 356d. Conversion privileges for insured former
spouses. (1) No individual policy of accident and health
insurance providing coverage of hospital and/or medical
expense on either an expense incurred basis or other than an
expense incurred basis, which in addition to covering the
insured also provides coverage to the spouse of the insured
shall contain a provision for termination of coverage for a
spouse covered under the policy solely as a result of a break
in the marital relationship except by reason of an entry of a
valid judgment of dissolution of marriage between the parties.
(2) Every policy which contains a provision for
termination of coverage of the spouse upon dissolution of
marriage shall contain a provision to the effect that upon the
entry of a valid judgment of dissolution of marriage between
the insured parties the spouse whose marriage was dissolved
shall be entitled to have issued to him or her, without
evidence of insurability, upon application made to the company
within 60 days following the entry of such judgment, and upon

HB5493 Engrossed - 31 - LRB103 39189 RPS 69335 b
the payment of the appropriate premium, an individual policy
of accident and health insurance. Such policy shall provide
the coverage then being issued by the insurer which is most
nearly similar to, but not greater than, such terminated
coverages. Any and all probationary and/or waiting periods set
forth in such policy shall be considered as being met to the
extent coverage was in force under the prior policy.
(3) The requirements of this Section shall apply to all
policies delivered or issued for delivery on or after the 60th
day following the effective date of this Section.
(Source: P.A. 84-545.)
(215 ILCS 5/356e) (from Ch. 73, par. 968e)
Sec. 356e. Victims of certain offenses.
(1) No individual policy of accident and health insurance,
which provides benefits for hospital or medical expenses based
upon the actual expenses incurred, delivered or issued for
delivery to any person in this State shall contain any
specific exception to coverage which would preclude the
payment under that policy of actual expenses incurred in the
examination and testing of a victim of an offense defined in
Sections 11-1.20 through 11-1.60 or 12-13 through 12-16 of the
Criminal Code of 1961 or the Criminal Code of 2012, or an
attempt to commit such offense to establish that sexual
contact did occur or did not occur, and to establish the
presence or absence of sexually transmitted disease or

HB5493 Engrossed - 32 - LRB103 39189 RPS 69335 b
infection, and examination and treatment of injuries and
trauma sustained by a victim of such offense arising out of the
offense. Every policy of accident and health insurance which
specifically provides benefits for routine physical
examinations shall provide full coverage for expenses incurred
in the examination and testing of a victim of an offense
defined in Sections 11-1.20 through 11-1.60 or 12-13 through
12-16 of the Criminal Code of 1961 or the Criminal Code of
2012, or an attempt to commit such offense as set forth in this
Section. This Section shall not apply to a policy which covers
hospital and medical expenses for specified illnesses or
injuries only.
(2) For purposes of enabling the recovery of State funds,
any insurance carrier subject to this Section shall upon
reasonable demand by the Department of Public Health disclose
the names and identities of its insureds entitled to benefits
under this provision to the Department of Public Health
whenever the Department of Public Health has determined that
it has paid, or is about to pay, hospital or medical expenses
for which an insurance carrier is liable under this Section.
All information received by the Department of Public Health
under this provision shall be held on a confidential basis and
shall not be subject to subpoena and shall not be made public
by the Department of Public Health or used for any purpose
other than that authorized by this Section.
(3) Whenever the Department of Public Health finds that it

HB5493 Engrossed - 33 - LRB103 39189 RPS 69335 b
has paid all or part of any hospital or medical expenses which
an insurance carrier is obligated to pay under this Section,
the Department of Public Health shall be entitled to receive
reimbursement for its payments from such insurance carrier
provided that the Department of Public Health has notified the
insurance carrier of its claims before the carrier has paid
such benefits to its insureds or in behalf of its insureds.
(Source: P.A. 96-1551, eff. 7-1-11; 97-1150, eff. 1-25-13.)
(215 ILCS 5/356f) (from Ch. 73, par. 968f)
Sec. 356f. No individual policy of accident or health
insurance or any renewal thereof shall be denied or cancelled
by the insurer, nor shall any such policy contain any
exception or exclusion of benefits, solely because the mother
of the insured has taken diethylstilbestrol, commonly referred
to as DES.
(Source: P.A. 81-656.)
(215 ILCS 5/356K) (from Ch. 73, par. 968K)
Sec. 356K. Coverage for Organ Transplantation Procedures.
No accident and health insurer providing individual accident
and health insurance coverage under this Act for hospital or
medical expenses shall deny reimbursement for an otherwise
covered expense incurred for any organ transplantation
procedure solely on the basis that such procedure is deemed
experimental or investigational unless supported by the

HB5493 Engrossed - 34 - LRB103 39189 RPS 69335 b
determination of the Office of Health Care Technology
Assessment within the Agency for Health Care Policy and
Research within the federal Department of Health and Human
Services that such procedure is either experimental or
investigational or that there is insufficient data or
experience to determine whether an organ transplantation
procedure is clinically acceptable. If an accident and health
insurer has made written request, or had one made on its behalf
by a national organization, for determination by the Office of
Health Care Technology Assessment within the Agency for Health
Care Policy and Research within the federal Department of
Health and Human Services as to whether a specific organ
transplantation procedure is clinically acceptable and said
organization fails to respond to such a request within a
period of 90 days, the failure to act may be deemed a
determination that the procedure is deemed to be experimental
or investigational.
(Source: P.A. 87-218.)
(215 ILCS 5/356L) (from Ch. 73, par. 968L)
Sec. 356L. No individual policy of accident or health
insurance shall include any provision which shall have the
effect of denying coverage to or on behalf of an insured under
such policy on the basis of a failure by the insured to file a
notice of claim within the time period required by the policy,
provided such failure is caused solely by the physical

HB5493 Engrossed - 35 - LRB103 39189 RPS 69335 b
inability or mental incapacity of the insured to file such
notice of claim because of a period of emergency
hospitalization.
(Source: P.A. 86-784.)
(215 ILCS 5/356r)
Sec. 356r. Access to obstetrical and gynecological care
Woman's principal health care provider.
(a) An individual or group policy of accident and health
insurance or a managed care plan amended, delivered, issued,
or renewed in this State must not require authorization or
referral by the plan, issuer, or any person, including a
primary care provider, for any covered individual who seeks
coverage for obstetrical or gynecological care provided by any
licensed or certified participating health care professional
who specializes in obstetrics or gynecology. after November
14, 1996 that requires an insured or enrollee to designate an
individual to coordinate care or to control access to health
care services shall also permit a female insured or enrollee
to designate a participating woman's principal health care
provider, and the insurer or managed care plan shall provide
the following written notice to all female insureds or
enrollees no later than 120 days after the effective date of
this amendatory Act of 1998; to all new enrollees at the time
of enrollment; and thereafter to all existing enrollees at
least annually, as a part of a regular publication or

HB5493 Engrossed - 36 - LRB103 39189 RPS 69335 b
informational mailing:
"NOTICE TO ALL FEMALE PLAN MEMBERS:
YOUR RIGHT TO SELECT A WOMAN'S PRINCIPAL
HEALTH CARE PROVIDER.
Illinois law allows you to select "a woman's principal
health care provider" in addition to your selection of a
primary care physician. A woman's principal health care
provider is a physician licensed to practice medicine in
all its branches specializing in obstetrics or gynecology
or specializing in family practice. A woman's principal
health care provider may be seen for care without
referrals from your primary care physician. If you have
not already selected a woman's principal health care
provider, you may do so now or at any other time. You are
not required to have or to select a woman's principal
health care provider.
Your woman's principal health care provider must be a
part of your plan. You may get the list of participating
obstetricians, gynecologists, and family practice
specialists from your employer's employee benefits
coordinator, or for your own copy of the current list, you
may call [insert plan's toll free number]. The list will
be sent to you within 10 days after your call. To designate
a woman's principal health care provider from the list,
call [insert plan's toll free number] and tell our staff
the name of the physician you have selected.".

HB5493 Engrossed - 37 - LRB103 39189 RPS 69335 b
If the insurer or managed care plan exercises the option set
forth in subsection (a-5), the notice shall also state:
"Your plan requires that your primary care physician
and your woman's principal health care provider have a
referral arrangement with one another. If the woman's
principal health care provider that you select does not
have a referral arrangement with your primary care
physician, you will have to select a new primary care
physician who has a referral arrangement with your woman's
principal health care provider or you may select a woman's
principal health care provider who has a referral
arrangement with your primary care physician. The list of
woman's principal health care providers will also have the
names of the primary care physicians and their referral
arrangements.".
No later than 120 days after the effective date of this
amendatory Act of 1998, the insurer or managed care plan shall
provide each employer who has a policy of insurance or a
managed care plan with the insurer or managed care plan with a
list of physicians licensed to practice medicine in all its
branches specializing in obstetrics or gynecology or
specializing in family practice who have contracted with the
plan. At the time of enrollment and thereafter within 10 days
after a request by an insured or enrollee, the insurer or
managed care plan also shall provide this list directly to the
insured or enrollee. The list shall include each physician's

HB5493 Engrossed - 38 - LRB103 39189 RPS 69335 b
address, telephone number, and specialty. No insurer or plan
formal or informal policy may restrict a female insured's or
enrollee's right to designate a woman's principal health care
provider, except as set forth in subsection (a-5). If the
female enrollee is an enrollee of a managed care plan under
contract with the Department of Healthcare and Family
Services, the physician chosen by the enrollee as her woman's
principal health care provider must be a Medicaid-enrolled
provider. This requirement does not require a female insured
or enrollee to make a selection of a woman's principal health
care provider. The female insured or enrollee may designate a
physician licensed to practice medicine in all its branches
specializing in family practice as her woman's principal
health care provider.
(a-5) If a policy, contract, or certificate requires or
allows a covered individual to designate a primary care
provider and provides coverage for any obstetrical or
gynecological care, the insurer shall provide the notice
required under 45 CFR 147.138(a)(4) and 149.310(a)(4) in all
circumstances required under that provision. The insured or
enrollee may be required by the insurer or managed care plan to
select a woman's principal health care provider who has a
referral arrangement with the insured's or enrollee's
individual who coordinates care or controls access to health
care services if such referral arrangement exists or to select
a new individual to coordinate care or to control access to

HB5493 Engrossed - 39 - LRB103 39189 RPS 69335 b
health care services who has a referral arrangement with the
woman's principal health care provider chosen by the insured
or enrollee, if such referral arrangement exists. If an
insurer or a managed care plan requires an insured or enrollee
to select a new physician under this subsection (a-5), the
insurer or managed care plan must provide the insured or
enrollee with both options to select a new physician provided
in this subsection (a-5).
Notwithstanding a plan's restrictions of the frequency or
timing of making designations of primary care providers, a
female enrollee or insured who is subject to the selection
requirements of this subsection, may, at any time, effect a
change in primary care physicians in order to make a selection
of a woman's principal health care provider.
(a-6) The requirements of this Section shall be construed
in a manner consistent with the requirements for access to and
notice of obstetrical and gynecological care in 45 CFR 147.138
and 45 CFR 149.310. If an insurer or managed care plan
exercises the option in subsection (a-5), the list to be
provided under subsection (a) shall identify the referral
arrangements that exist between the individual who coordinates
care or controls access to health care services and the
woman's principal health care provider in order to assist the
female insured or enrollee to make a selection within the
insurer's or managed care plan's requirement.
(b) Nothing in this Section prevents a health insurance

HB5493 Engrossed - 40 - LRB103 39189 RPS 69335 b
issuer from requiring a participating obstetrical or
gynecological health care professional to agree, with respect
to individuals covered under a policy of accident and health
insurance, to otherwise adhere to the health insurance
issuer's policies and procedures, including procedures
regarding referrals and obtaining prior authorization and
providing services pursuant to a treatment plan, if any,
approved by the issuer. If a female insured or enrollee has
designated a woman's principal health care provider, then the
insured or enrollee must be given direct access to the woman's
principal health care provider for services covered by the
policy or plan without the need for a referral or prior
approval. Nothing shall prohibit the insurer or managed care
plan from requiring prior authorization or approval from
either a primary care provider or the woman's principal health
care provider for referrals for additional care or services.
(c) (Blank). For the purposes of this Section the
following terms are defined:
(1) "Woman's principal health care provider" means a
physician licensed to practice medicine in all of its
branches specializing in obstetrics or gynecology or
specializing in family practice.
(2) "Managed care entity" means any entity including a
licensed insurance company, hospital or medical service
plan, health maintenance organization, limited health
service organization, preferred provider organization,

HB5493 Engrossed - 41 - LRB103 39189 RPS 69335 b
third party administrator, an employer or employee
organization, or any person or entity that establishes,
operates, or maintains a network of participating
providers.
(3) "Managed care plan" means a plan operated by a
managed care entity that provides for the financing of
health care services to persons enrolled in the plan
through:
(A) organizational arrangements for ongoing
quality assurance, utilization review programs, or
dispute resolution; or
(B) financial incentives for persons enrolled in
the plan to use the participating providers and
procedures covered by the plan.
(4) "Participating provider" means a physician who has
contracted with an insurer or managed care plan to provide
services to insureds or enrollees as defined by the
contract.
(d) Nothing in this Section shall be construed to preclude
a health insurance issuer from requiring that a participating
obstetrical or gynecological health care professional notify
the covered individual's primary care physician or the issuer
of treatment decisions or update centralized medical records.
The original provisions of this Section became law on July 17,
1996 and took effect November 14, 1996, which is 120 days after
becoming law.

HB5493 Engrossed - 42 - LRB103 39189 RPS 69335 b
(Source: P.A. 95-331, eff. 8-21-07.)
(215 ILCS 5/356s)
Sec. 356s. Post-parturition care. An individual or group
policy of accident and health insurance that provides
maternity coverage and is amended, delivered, issued, or
renewed after the effective date of this amendatory Act of
1996 shall provide coverage for the following:
(1) a minimum of 48 hours of inpatient care following
a vaginal delivery for the mother and the newborn, except
as otherwise provided in this Section; or
(2) a minimum of 96 hours of inpatient care following
a delivery by caesarian section for the mother and
newborn, except as otherwise provided in this Section.
Coverage may be limited to a A shorter length of hospital
inpatient care stay for services related to maternity and
newborn care may be provided if the attending physician
licensed to practice medicine in all of its branches
determines, in accordance with the protocols and guidelines
developed by the American College of Obstetricians and
Gynecologists or the American Academy of Pediatrics, that the
mother and the newborn meet the appropriate guidelines for
that length of stay based upon evaluation of the mother and
newborn and the coverage and availability of a post-discharge
physician office visit or in-home nurse visit to verify the
condition of the infant in the first 48 hours after discharge.

HB5493 Engrossed - 43 - LRB103 39189 RPS 69335 b
(Source: P.A. 89-513, eff. 9-15-96; 90-14, eff. 7-1-97.)
(215 ILCS 5/356z.3)
Sec. 356z.3. Disclosure of limited benefit. An insurer
that issues, delivers, amends, or renews an individual or
group policy of accident and health insurance in this State
after the effective date of this amendatory Act of the 92nd
General Assembly and arranges, contracts with, or administers
contracts with a provider whereby beneficiaries are provided
an incentive to use the services of such provider must include
the following disclosure on its contracts and evidences of
coverage: "WARNING, LIMITED BENEFITS WILL BE PAID WHEN
NON-PARTICIPATING PROVIDERS ARE USED. YOU CAN EXPECT TO PAY
MORE THAN THE COST-SHARING AMOUNT DEFINED IN THE POLICY IN
NON-EMERGENCY SITUATIONS. Except in limited situations
governed by the federal No Surprises Act or Section 356z.3a of
the Illinois Insurance Code (215 ILCS 5/356z.3a),
non-participating providers furnishing non-emergency services
may bill members for any amount up to the billed charge after
the plan has paid its portion of the bill. If you elect to use
a non-participating provider, plan benefit payments will be
determined according to your policy's fee schedule, usual and
customary charge (which is determined by comparing charges for
similar services adjusted to the geographical area where the
services are performed), or other method as defined by the
policy. Participating providers have agreed to ONLY bill

HB5493 Engrossed - 44 - LRB103 39189 RPS 69335 b
members the cost-sharing amounts. You should be aware that
when you elect to utilize the services of a non-participating
provider for a covered service in non-emergency situations,
benefit payments to such non-participating provider are not
based upon the amount billed. The basis of your benefit
payment will be determined according to your policy's fee
schedule, usual and customary charge (which is determined by
comparing charges for similar services adjusted to the
geographical area where the services are performed), or other
method as defined by the policy. YOU CAN EXPECT TO PAY MORE
THAN THE COINSURANCE AMOUNT DEFINED IN THE POLICY AFTER THE
PLAN HAS PAID ITS REQUIRED PORTION. Non-participating
providers may bill members for any amount up to the billed
charge after the plan has paid its portion of the bill, except
as provided in Section 356z.3a of the Illinois Insurance Code
for covered services received at a participating health care
facility from a nonparticipating provider that are: (a)
ancillary services, (b) items or services furnished as a
result of unforeseen, urgent medical needs that arise at the
time the item or service is furnished, or (c) items or services
received when the facility or the non-participating provider
fails to satisfy the notice and consent criteria specified
under Section 356z.3a. Participating providers have agreed to
accept discounted payments for services with no additional
billing to the member other than co-insurance and deductible
amounts. You may obtain further information about the

HB5493 Engrossed - 45 - LRB103 39189 RPS 69335 b
participating status of professional providers and information
on out-of-pocket expenses by calling the toll-free toll free
telephone number on your identification card.".
(Source: P.A. 102-901, eff. 1-1-23.)
(215 ILCS 5/356z.33)
(Text of Section before amendment by P.A. 103-454)
Sec. 356z.33. Coverage for epinephrine injectors. 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, 2020 (the effective date of
Public Act 101-281) shall provide coverage for medically
necessary epinephrine injectors for persons 18 years of age or
under. As used in this Section, "epinephrine injector" has the
meaning given to that term in Section 5 of the Epinephrine
Injector Act.
(Source: P.A. 101-281, eff. 1-1-20; 102-558, eff. 8-20-21.)
(Text of Section after amendment by P.A. 103-454)
Sec. 356z.33. Coverage for epinephrine injectors.
(a) 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, 2020 (the effective
date of Public Act 101-281) shall provide coverage for
medically necessary epinephrine injectors for persons 18 years
of age or under. As used in this Section, "epinephrine

HB5493 Engrossed - 46 - LRB103 39189 RPS 69335 b
injector" has the meaning given to that term in Section 5 of
the Epinephrine Injector Act.
(b) An insurer that provides coverage for medically
necessary epinephrine injectors shall limit the total amount
that an insured is required to pay for a twin-pack of medically
necessary epinephrine injectors at an amount not to exceed
$60, regardless of the type of epinephrine injector; except
that this provision does not apply to the extent such coverage
would disqualify a high-deductible health plan from
eligibility for a health savings account pursuant to Section
223 of the Internal Revenue Code (26 U.S.C. 223).
(c) Nothing in this Section prevents an insurer from
reducing an insured's cost sharing by an amount greater than
the amount specified in subsection (b).
(d) The Department may adopt rules as necessary to
implement and administer this Section.
(Source: P.A. 102-558, eff. 8-20-21; 103-454, eff. 1-1-25.)
(215 ILCS 5/367a) (from Ch. 73, par. 979a)
Sec. 367a. Blanket accident and health insurance.
(1) Blanket accident and health insurance is that form of
accident and health insurance covering special groups of
persons as enumerated in one of the following paragraphs (a)
to (g), inclusive:
(a) Under a policy or contract issued to any carrier
for hire, which shall be deemed the policyholder, covering

HB5493 Engrossed - 47 - LRB103 39189 RPS 69335 b
a group defined as all persons who may become passengers
on such carrier.
(b) Under a policy or contract issued to an employer,
who shall be deemed the policyholder, covering all
employees or any group of employees defined by reference
to exceptional hazards incident to such employment.
(c) Under a policy or contract issued to a college,
school, or other institution of learning or to the head or
principal thereof, who or which shall be deemed the
policyholder, covering students or teachers. However,
student health insurance coverage, as defined in 45 CFR
147.145, shall remain subject to the standards and
requirements for individual health insurance coverage
except where inconsistent with that regulation. Student
health insurance coverage shall not be subject to the
Short-Term, Limited-Duration Health Insurance Coverage
Act. An insurer providing student health insurance
coverage or a policy or contract covering students for
limited-scope dental or vision under 45 CFR 148.220 shall
require an individual application or enrollment form and
shall furnish each insured individual a certificate, which
shall have been approved by the Director under Section
355.
(d) Under a policy or contract issued in the name of
any volunteer fire department, first aid, or other such
volunteer group, which shall be deemed the policyholder,

HB5493 Engrossed - 48 - LRB103 39189 RPS 69335 b
covering all of the members of such department or group.
(e) Under a policy or contract issued to a creditor,
who shall be deemed the policyholder, to insure debtors of
the creditors; Provided, however, that in the case of a
loan which is subject to the Small Loans Act, no insurance
premium or other cost shall be directly or indirectly
charged or assessed against, or collected or received from
the borrower.
(f) Under a policy or contract issued to a sports team
or to a camp, which team or camp sponsor shall be deemed
the policyholder, covering members or campers.
(g) Under a policy or contract issued to any other
substantially similar group which, in the discretion of
the Director, may be subject to the issuance of a blanket
accident and health policy or contract.
(2) Any insurance company authorized to write accident and
health insurance in this state shall have the power to issue
blanket accident and health insurance. No such blanket policy
may be issued or delivered in this State unless a copy of the
form thereof shall have been filed in accordance with Section
355, and it contains in substance such of those provisions
contained in Sections 357.1 through 357.30 as may be
applicable to blanket accident and health insurance and the
following provisions:
(a) A provision that the policy and the application
shall constitute the entire contract between the parties,

HB5493 Engrossed - 49 - LRB103 39189 RPS 69335 b
and that all statements made by the policyholder shall, in
absence of fraud, be deemed representations and not
warranties, and that no such statements shall be used in
defense to a claim under the policy, unless it is
contained in a written application.
(b) A provision that to the group or class thereof
originally insured shall be added from time to time all
new persons or individuals eligible for coverage.
(3) An individual application shall not be required from a
person covered under a blanket accident or health policy or
contract, nor shall it be necessary for the insurer to furnish
each person a certificate.
(3.5) Subsection (3) does not apply to major medical
insurance, or to any excepted benefits or short-term,
limited-duration health insurance coverage for which an
insured individual pays premiums or contributions. In those
cases, the insurer shall require an individual application or
enrollment form and shall furnish each insured individual a
certificate, which shall have been approved by the Director
under Section 355 of this Code.
(4) All benefits under any blanket accident and health
policy shall be payable to the person insured, or to his
designated beneficiary or beneficiaries, or to his or her
estate, except that if the person insured be a minor or person
under legal disability, such benefits may be made payable to
his or her parent, guardian, or other person actually

HB5493 Engrossed - 50 - LRB103 39189 RPS 69335 b
supporting him or her. Provided further, however, that the
policy may provide that all or any portion of any indemnities
provided by any such policy on account of hospital, nursing,
medical or surgical services may, at the insurer's option, be
paid directly to the hospital or person rendering such
services; but the policy may not require that the service be
rendered by a particular hospital or person. Payment so made
shall discharge the insurer's obligation with respect to the
amount of insurance so paid.
(5) Nothing contained in this section shall be deemed to
affect the legal liability of policyholders for the death of
or injury to, any such member of such group.
(Source: P.A. 83-1362.)
(215 ILCS 5/370e) (from Ch. 73, par. 982e)
Sec. 370e. Companies which issue group accident and health
policies or blanket accident and health plans to employer
groups in this State shall provide the employer with notice of
termination of a group or blanket accident and health plan
because of the employer's failure to pay the premium when due.
The insurance company shall file send a copy of such notice
with to the Department in an electronic format either through
the System for Electronic Rate and Form Filing (SERFF) or as
otherwise prescribed by the Director.
(Source: P.A. 83-1006.)

HB5493 Engrossed - 51 - LRB103 39189 RPS 69335 b
(215 ILCS 5/370i) (from Ch. 73, par. 982i)
Sec. 370i. Policies, agreements or arrangements with
incentives or limits on reimbursement authorized.
(a) Policies, agreements or arrangements issued under this
Article may not contain terms or conditions that would operate
unreasonably to restrict the access and availability of health
care services for the insured.
(b) An insurer or administrator may:
(1) enter into agreements with certain providers of
its choice relating to health care services which may be
rendered to insureds or beneficiaries of the insurer or
administrator, including agreements relating to the
amounts to be charged the insureds or beneficiaries for
services rendered;
(2) issue or administer programs, policies or
subscriber contracts in this State that include incentives
for the insured or beneficiary to utilize the services of
a provider which has entered into an agreement with the
insurer or administrator pursuant to paragraph (1) above.
(c) (Blank). After the effective date of this amendatory
Act of the 92nd General Assembly, any insurer that arranges,
contracts with, or administers contracts with a provider
whereby beneficiaries are provided an incentive to use the
services of such provider must include the following
disclosure on its contracts and evidences of coverage:
"WARNING, LIMITED BENEFITS WILL BE PAID WHEN NON-PARTICIPATING

HB5493 Engrossed - 52 - LRB103 39189 RPS 69335 b
PROVIDERS ARE USED. You should be aware that when you elect to
utilize the services of a non-participating provider for a
covered service in non-emergency situations, benefit payments
to such non-participating provider are not based upon the
amount billed. The basis of your benefit payment will be
determined according to your policy's fee schedule, usual and
customary charge (which is determined by comparing charges for
similar services adjusted to the geographical area where the
services are performed), or other method as defined by the
policy. YOU CAN EXPECT TO PAY MORE THAN THE COINSURANCE AMOUNT
DEFINED IN THE POLICY AFTER THE PLAN HAS PAID ITS REQUIRED
PORTION. Non-participating providers may bill members for any
amount up to the billed charge after the plan has paid its
portion of the bill. Participating providers have agreed to
accept discounted payments for services with no additional
billing to the member other than co-insurance and deductible
amounts. You may obtain further information about the
participating status of professional providers and information
on out-of-pocket expenses by calling the toll free telephone
number on your identification card.".
(Source: P.A. 92-579, eff. 1-1-03.)
(215 ILCS 5/408) (from Ch. 73, par. 1020)
(Text of Section before amendment by P.A. 103-75)
Sec. 408. Fees and charges.
(1) The Director shall charge, collect and give proper

HB5493 Engrossed - 53 - LRB103 39189 RPS 69335 b
acquittances for the payment of the following fees and
charges:
(a) For filing all documents submitted for the
incorporation or organization or certification of a
domestic company, except for a fraternal benefit society,
$2,000.
(b) For filing all documents submitted for the
incorporation or organization of a fraternal benefit
society, $500.
(c) For filing amendments to articles of incorporation
and amendments to declaration of organization, except for
a fraternal benefit society, a mutual benefit association,
a burial society or a farm mutual, $200.
(d) For filing amendments to articles of incorporation
of a fraternal benefit society, a mutual benefit
association or a burial society, $100.
(e) For filing amendments to articles of incorporation
of a farm mutual, $50.
(f) For filing bylaws or amendments thereto, $50.
(g) For filing agreement of merger or consolidation:
(i) for a domestic company, except for a fraternal
benefit society, a mutual benefit association, a
burial society, or a farm mutual, $2,000.
(ii) for a foreign or alien company, except for a
fraternal benefit society, $600.
(iii) for a fraternal benefit society, a mutual

HB5493 Engrossed - 54 - LRB103 39189 RPS 69335 b
benefit association, a burial society, or a farm
mutual, $200.
(h) For filing agreements of reinsurance by a domestic
company, $200.
(i) For filing all documents submitted by a foreign or
alien company to be admitted to transact business or
accredited as a reinsurer in this State, except for a
fraternal benefit society, $5,000.
(j) For filing all documents submitted by a foreign or
alien fraternal benefit society to be admitted to transact
business in this State, $500.
(k) For filing declaration of withdrawal of a foreign
or alien company, $50.
(l) For filing annual statement by a domestic company,
except a fraternal benefit society, a mutual benefit
association, a burial society, or a farm mutual, $200.
(m) For filing annual statement by a domestic
fraternal benefit society, $100.
(n) For filing annual statement by a farm mutual, a
mutual benefit association, or a burial society, $50.
(o) For issuing a certificate of authority or renewal
thereof except to a foreign fraternal benefit society,
$400.
(p) For issuing a certificate of authority or renewal
thereof to a foreign fraternal benefit society, $200.
(q) For issuing an amended certificate of authority,

HB5493 Engrossed - 55 - LRB103 39189 RPS 69335 b
$50.
(r) For each certified copy of certificate of
authority, $20.
(s) For each certificate of deposit, or valuation, or
compliance or surety certificate, $20.
(t) For copies of papers or records per page, $1.
(u) For each certification to copies of papers or
records, $10.
(v) For multiple copies of documents or certificates
listed in subparagraphs (r), (s), and (u) of paragraph (1)
of this Section, $10 for the first copy of a certificate of
any type and $5 for each additional copy of the same
certificate requested at the same time, unless, pursuant
to paragraph (2) of this Section, the Director finds these
additional fees excessive.
(w) For issuing a permit to sell shares or increase
paid-up capital:
(i) in connection with a public stock offering,
$300;
(ii) in any other case, $100.
(x) For issuing any other certificate required or
permissible under the law, $50.
(y) For filing a plan of exchange of the stock of a
domestic stock insurance company, a plan of
demutualization of a domestic mutual company, or a plan of
reorganization under Article XII, $2,000.

HB5493 Engrossed - 56 - LRB103 39189 RPS 69335 b
(z) For filing a statement of acquisition of a
domestic company as defined in Section 131.4 of this Code,
$2,000.
(aa) For filing an agreement to purchase the business
of an organization authorized under the Dental Service
Plan Act or the Voluntary Health Services Plans Act or of a
health maintenance organization or a limited health
service organization, $2,000.
(bb) For filing a statement of acquisition of a
foreign or alien insurance company as defined in Section
131.12a of this Code, $1,000.
(cc) For filing a registration statement as required
in Sections 131.13 and 131.14, the notification as
required by Sections 131.16, 131.20a, or 141.4, or an
agreement or transaction required by Sections 124.2(2),
141, 141a, or 141.1, $200.
(dd) For filing an application for licensing of:
(i) a religious or charitable risk pooling trust
or a workers' compensation pool, $1,000;
(ii) a workers' compensation service company,
$500;
(iii) a self-insured automobile fleet, $200; or
(iv) a renewal of or amendment of any license
issued pursuant to (i), (ii), or (iii) above, $100.
(ee) For filing articles of incorporation for a
syndicate to engage in the business of insurance through

HB5493 Engrossed - 57 - LRB103 39189 RPS 69335 b
the Illinois Insurance Exchange, $2,000.
(ff) For filing amended articles of incorporation for
a syndicate engaged in the business of insurance through
the Illinois Insurance Exchange, $100.
(gg) For filing articles of incorporation for a
limited syndicate to join with other subscribers or
limited syndicates to do business through the Illinois
Insurance Exchange, $1,000.
(hh) For filing amended articles of incorporation for
a limited syndicate to do business through the Illinois
Insurance Exchange, $100.
(ii) For a permit to solicit subscriptions to a
syndicate or limited syndicate, $100.
(jj) For the filing of each form as required in
Section 143 of this Code, $50 per form. Informational and
advertising filings shall be $25 per filing. The fee for
advisory and rating organizations shall be $200 per form.
(i) For the purposes of the form filing fee,
filings made on insert page basis will be considered
one form at the time of its original submission.
Changes made to a form subsequent to its approval
shall be considered a new filing.
(ii) Only one fee shall be charged for a form,
regardless of the number of other forms or policies
with which it will be used.
(iii) Fees charged for a policy filed as it will be

HB5493 Engrossed - 58 - LRB103 39189 RPS 69335 b
issued regardless of the number of forms comprising
that policy shall not exceed $1,500. For advisory or
rating organizations, fees charged for a policy filed
as it will be issued regardless of the number of forms
comprising that policy shall not exceed $2,500.
(iv) The Director may by rule exempt forms from
such fees.
(kk) For filing an application for licensing of a
reinsurance intermediary, $500.
(ll) For filing an application for renewal of a
license of a reinsurance intermediary, $200.
(mm) For filing a plan of division of a domestic stock
company under Article IIB, $100,000 $10,000.
(nn) For filing all documents submitted by a foreign
or alien company to be a certified reinsurer in this
State, except for a fraternal benefit society, $1,000.
(oo) For filing a renewal by a foreign or alien
company to be a certified reinsurer in this State, except
for a fraternal benefit society, $400.
(pp) For filing all documents submitted by a reinsurer
domiciled in a reciprocal jurisdiction, $1,000.
(qq) For filing a renewal by a reinsurer domiciled in
a reciprocal jurisdiction, $400.
(rr) For registering a captive management company or
renewal thereof, $50.
(2) When printed copies or numerous copies of the same

HB5493 Engrossed - 59 - LRB103 39189 RPS 69335 b
paper or records are furnished or certified, the Director may
reduce such fees for copies if he finds them excessive. He may,
when he considers it in the public interest, furnish without
charge to state insurance departments and persons other than
companies, copies or certified copies of reports of
examinations and of other papers and records.
(3) The expenses incurred in any performance examination
authorized by law shall be paid by the company or person being
examined. The charge shall be reasonably related to the cost
of the examination including but not limited to compensation
of examiners, electronic data processing costs, supervision
and preparation of an examination report and lodging and
travel expenses. All lodging and travel expenses shall be in
accord with the applicable travel regulations as published by
the Department of Central Management Services and approved by
the Governor's Travel Control Board, except that out-of-state
lodging and travel expenses related to examinations authorized
under Section 132 shall be in accordance with travel rates
prescribed under paragraph 301-7.2 of the Federal Travel
Regulations, 41 CFR C.F.R. 301-7.2, for reimbursement of
subsistence expenses incurred during official travel. All
lodging and travel expenses may be reimbursed directly upon
authorization of the Director. With the exception of the
direct reimbursements authorized by the Director, all
performance examination charges collected by the Department
shall be paid to the Insurance Producer Administration Fund,

HB5493 Engrossed - 60 - LRB103 39189 RPS 69335 b
however, the electronic data processing costs incurred by the
Department in the performance of any examination shall be
billed directly to the company being examined for payment to
the Technology Management Revolving Fund.
(4) At the time of any service of process on the Director
as attorney for such service, the Director shall charge and
collect the sum of $40, which may be recovered as taxable costs
by the party to the suit or action causing such service to be
made if he prevails in such suit or action.
(5) (a) The costs incurred by the Department of Insurance
in conducting any hearing authorized by law shall be assessed
against the parties to the hearing in such proportion as the
Director of Insurance may determine upon consideration of all
relevant circumstances including: (1) the nature of the
hearing; (2) whether the hearing was instigated by, or for the
benefit of a particular party or parties; (3) whether there is
a successful party on the merits of the proceeding; and (4) the
relative levels of participation by the parties.
(b) For purposes of this subsection (5) costs incurred
shall mean the hearing officer fees, court reporter fees, and
travel expenses of Department of Insurance officers and
employees; provided however, that costs incurred shall not
include hearing officer fees or court reporter fees unless the
Department has retained the services of independent
contractors or outside experts to perform such functions.
(c) The Director shall make the assessment of costs

HB5493 Engrossed - 61 - LRB103 39189 RPS 69335 b
incurred as part of the final order or decision arising out of
the proceeding; provided, however, that such order or decision
shall include findings and conclusions in support of the
assessment of costs. This subsection (5) shall not be
construed as permitting the payment of travel expenses unless
calculated in accordance with the applicable travel
regulations of the Department of Central Management Services,
as approved by the Governor's Travel Control Board. The
Director as part of such order or decision shall require all
assessments for hearing officer fees and court reporter fees,
if any, to be paid directly to the hearing officer or court
reporter by the party(s) assessed for such costs. The
assessments for travel expenses of Department officers and
employees shall be reimbursable to the Director of Insurance
for deposit to the fund out of which those expenses had been
paid.
(d) The provisions of this subsection (5) shall apply in
the case of any hearing conducted by the Director of Insurance
not otherwise specifically provided for by law.
(6) The Director shall charge and collect an annual
financial regulation fee from every domestic company for
examination and analysis of its financial condition and to
fund the internal costs and expenses of the Interstate
Insurance Receivership Commission as may be allocated to the
State of Illinois and companies doing an insurance business in
this State pursuant to Article X of the Interstate Insurance

HB5493 Engrossed - 62 - LRB103 39189 RPS 69335 b
Receivership Compact. The fee shall be the greater fixed
amount based upon the combination of nationwide direct premium
income and nationwide reinsurance assumed premium income or
upon admitted assets calculated under this subsection as
follows:
(a) Combination of nationwide direct premium income
and nationwide reinsurance assumed premium.
(i) $150, if the premium is less than $500,000 and
there is no reinsurance assumed premium;
(ii) $750, if the premium is $500,000 or more, but
less than $5,000,000 and there is no reinsurance
assumed premium; or if the premium is less than
$5,000,000 and the reinsurance assumed premium is less
than $10,000,000;
(iii) $3,750, if the premium is less than
$5,000,000 and the reinsurance assumed premium is
$10,000,000 or more;
(iv) $7,500, if the premium is $5,000,000 or more,
but less than $10,000,000;
(v) $18,000, if the premium is $10,000,000 or
more, but less than $25,000,000;
(vi) $22,500, if the premium is $25,000,000 or
more, but less than $50,000,000;
(vii) $30,000, if the premium is $50,000,000 or
more, but less than $100,000,000;
(viii) $37,500, if the premium is $100,000,000 or

HB5493 Engrossed - 63 - LRB103 39189 RPS 69335 b
more.
(b) Admitted assets.
(i) $150, if admitted assets are less than
$1,000,000;
(ii) $750, if admitted assets are $1,000,000 or
more, but less than $5,000,000;
(iii) $3,750, if admitted assets are $5,000,000 or
more, but less than $25,000,000;
(iv) $7,500, if admitted assets are $25,000,000 or
more, but less than $50,000,000;
(v) $18,000, if admitted assets are $50,000,000 or
more, but less than $100,000,000;
(vi) $22,500, if admitted assets are $100,000,000
or more, but less than $500,000,000;
(vii) $30,000, if admitted assets are $500,000,000
or more, but less than $1,000,000,000;
(viii) $37,500, if admitted assets are
$1,000,000,000 or more.
(c) The sum of financial regulation fees charged to
the domestic companies of the same affiliated group shall
not exceed $250,000 in the aggregate in any single year
and shall be billed by the Director to the member company
designated by the group.
(7) The Director shall charge and collect an annual
financial regulation fee from every foreign or alien company,
except fraternal benefit societies, for the examination and

HB5493 Engrossed - 64 - LRB103 39189 RPS 69335 b
analysis of its financial condition and to fund the internal
costs and expenses of the Interstate Insurance Receivership
Commission as may be allocated to the State of Illinois and
companies doing an insurance business in this State pursuant
to Article X of the Interstate Insurance Receivership Compact.
The fee shall be a fixed amount based upon Illinois direct
premium income and nationwide reinsurance assumed premium
income in accordance with the following schedule:
(a) $150, if the premium is less than $500,000 and
there is no reinsurance assumed premium;
(b) $750, if the premium is $500,000 or more, but less
than $5,000,000 and there is no reinsurance assumed
premium; or if the premium is less than $5,000,000 and the
reinsurance assumed premium is less than $10,000,000;
(c) $3,750, if the premium is less than $5,000,000 and
the reinsurance assumed premium is $10,000,000 or more;
(d) $7,500, if the premium is $5,000,000 or more, but
less than $10,000,000;
(e) $18,000, if the premium is $10,000,000 or more,
but less than $25,000,000;
(f) $22,500, if the premium is $25,000,000 or more,
but less than $50,000,000;
(g) $30,000, if the premium is $50,000,000 or more,
but less than $100,000,000;
(h) $37,500, if the premium is $100,000,000 or more.
The sum of financial regulation fees under this subsection

HB5493 Engrossed - 65 - LRB103 39189 RPS 69335 b
(7) charged to the foreign or alien companies within the same
affiliated group shall not exceed $250,000 in the aggregate in
any single year and shall be billed by the Director to the
member company designated by the group.
(8) Beginning January 1, 1992, the financial regulation
fees imposed under subsections (6) and (7) of this Section
shall be paid by each company or domestic affiliated group
annually. After January 1, 1994, the fee shall be billed by
Department invoice based upon the company's premium income or
admitted assets as shown in its annual statement for the
preceding calendar year. The invoice is due upon receipt and
must be paid no later than June 30 of each calendar year. All
financial regulation fees collected by the Department shall be
paid to the Insurance Financial Regulation Fund. The
Department may not collect financial examiner per diem charges
from companies subject to subsections (6) and (7) of this
Section undergoing financial examination after June 30, 1992.
(9) In addition to the financial regulation fee required
by this Section, a company undergoing any financial
examination authorized by law shall pay the following costs
and expenses incurred by the Department: electronic data
processing costs, the expenses authorized under Section 131.21
and subsection (d) of Section 132.4 of this Code, and lodging
and travel expenses.
Electronic data processing costs incurred by the
Department in the performance of any examination shall be

HB5493 Engrossed - 66 - LRB103 39189 RPS 69335 b
billed directly to the company undergoing examination for
payment to the Technology Management Revolving Fund. Except
for direct reimbursements authorized by the Director or direct
payments made under Section 131.21 or subsection (d) of
Section 132.4 of this Code, all financial regulation fees and
all financial examination charges collected by the Department
shall be paid to the Insurance Financial Regulation Fund.
All lodging and travel expenses shall be in accordance
with applicable travel regulations published by the Department
of Central Management Services and approved by the Governor's
Travel Control Board, except that out-of-state lodging and
travel expenses related to examinations authorized under
Sections 132.1 through 132.7 shall be in accordance with
travel rates prescribed under paragraph 301-7.2 of the Federal
Travel Regulations, 41 CFR C.F.R. 301-7.2, for reimbursement
of subsistence expenses incurred during official travel. All
lodging and travel expenses may be reimbursed directly upon
the authorization of the Director.
In the case of an organization or person not subject to the
financial regulation fee, the expenses incurred in any
financial examination authorized by law shall be paid by the
organization or person being examined. The charge shall be
reasonably related to the cost of the examination including,
but not limited to, compensation of examiners and other costs
described in this subsection.
(10) Any company, person, or entity failing to make any

HB5493 Engrossed - 67 - LRB103 39189 RPS 69335 b
payment of $150 or more as required under this Section shall be
subject to the penalty and interest provisions provided for in
subsections (4) and (7) of Section 412.
(11) Unless otherwise specified, all of the fees collected
under this Section shall be paid into the Insurance Financial
Regulation Fund.
(12) For purposes of this Section:
(a) "Domestic company" means a company as defined in
Section 2 of this Code which is incorporated or organized
under the laws of this State, and in addition includes a
not-for-profit corporation authorized under the Dental
Service Plan Act or the Voluntary Health Services Plans
Act, a health maintenance organization, and a limited
health service organization.
(b) "Foreign company" means a company as defined in
Section 2 of this Code which is incorporated or organized
under the laws of any state of the United States other than
this State and in addition includes a health maintenance
organization and a limited health service organization
which is incorporated or organized under the laws of any
state of the United States other than this State.
(c) "Alien company" means a company as defined in
Section 2 of this Code which is incorporated or organized
under the laws of any country other than the United
States.
(d) "Fraternal benefit society" means a corporation,

HB5493 Engrossed - 68 - LRB103 39189 RPS 69335 b
society, order, lodge or voluntary association as defined
in Section 282.1 of this Code.
(e) "Mutual benefit association" means a company,
association or corporation authorized by the Director to
do business in this State under the provisions of Article
XVIII of this Code.
(f) "Burial society" means a person, firm,
corporation, society or association of individuals
authorized by the Director to do business in this State
under the provisions of Article XIX of this Code.
(g) "Farm mutual" means a district, county and
township mutual insurance company authorized by the
Director to do business in this State under the provisions
of the Farm Mutual Insurance Company Act of 1986.
(Source: P.A. 102-775, eff. 5-13-22.)
(Text of Section after amendment by P.A. 103-75)
Sec. 408. Fees and charges.
(1) The Director shall charge, collect and give proper
acquittances for the payment of the following fees and
charges:
(a) For filing all documents submitted for the
incorporation or organization or certification of a
domestic company, except for a fraternal benefit society,
$2,000.
(b) For filing all documents submitted for the

HB5493 Engrossed - 69 - LRB103 39189 RPS 69335 b
incorporation or organization of a fraternal benefit
society, $500.
(c) For filing amendments to articles of incorporation
and amendments to declaration of organization, except for
a fraternal benefit society, a mutual benefit association,
a burial society or a farm mutual, $200.
(d) For filing amendments to articles of incorporation
of a fraternal benefit society, a mutual benefit
association or a burial society, $100.
(e) For filing amendments to articles of incorporation
of a farm mutual, $50.
(f) For filing bylaws or amendments thereto, $50.
(g) For filing agreement of merger or consolidation:
(i) for a domestic company, except for a fraternal
benefit society, a mutual benefit association, a
burial society, or a farm mutual, $2,000.
(ii) for a foreign or alien company, except for a
fraternal benefit society, $600.
(iii) for a fraternal benefit society, a mutual
benefit association, a burial society, or a farm
mutual, $200.
(h) For filing agreements of reinsurance by a domestic
company, $200.
(i) For filing all documents submitted by a foreign or
alien company to be admitted to transact business or
accredited as a reinsurer in this State, except for a

HB5493 Engrossed - 70 - LRB103 39189 RPS 69335 b
fraternal benefit society, $5,000.
(j) For filing all documents submitted by a foreign or
alien fraternal benefit society to be admitted to transact
business in this State, $500.
(k) For filing declaration of withdrawal of a foreign
or alien company, $50.
(l) For filing annual statement by a domestic company,
except a fraternal benefit society, a mutual benefit
association, a burial society, or a farm mutual, $200.
(m) For filing annual statement by a domestic
fraternal benefit society, $100.
(n) For filing annual statement by a farm mutual, a
mutual benefit association, or a burial society, $50.
(o) For issuing a certificate of authority or renewal
thereof except to a foreign fraternal benefit society,
$400.
(p) For issuing a certificate of authority or renewal
thereof to a foreign fraternal benefit society, $200.
(q) For issuing an amended certificate of authority,
$50.
(r) For each certified copy of certificate of
authority, $20.
(s) For each certificate of deposit, or valuation, or
compliance or surety certificate, $20.
(t) For copies of papers or records per page, $1.
(u) For each certification to copies of papers or

HB5493 Engrossed - 71 - LRB103 39189 RPS 69335 b
records, $10.
(v) For multiple copies of documents or certificates
listed in subparagraphs (r), (s), and (u) of paragraph (1)
of this Section, $10 for the first copy of a certificate of
any type and $5 for each additional copy of the same
certificate requested at the same time, unless, pursuant
to paragraph (2) of this Section, the Director finds these
additional fees excessive.
(w) For issuing a permit to sell shares or increase
paid-up capital:
(i) in connection with a public stock offering,
$300;
(ii) in any other case, $100.
(x) For issuing any other certificate required or
permissible under the law, $50.
(y) For filing a plan of exchange of the stock of a
domestic stock insurance company, a plan of
demutualization of a domestic mutual company, or a plan of
reorganization under Article XII, $2,000.
(z) For filing a statement of acquisition of a
domestic company as defined in Section 131.4 of this Code,
$2,000.
(aa) For filing an agreement to purchase the business
of an organization authorized under the Dental Service
Plan Act or the Voluntary Health Services Plans Act or of a
health maintenance organization or a limited health

HB5493 Engrossed - 72 - LRB103 39189 RPS 69335 b
service organization, $2,000.
(bb) For filing a statement of acquisition of a
foreign or alien insurance company as defined in Section
131.12a of this Code, $1,000.
(cc) For filing a registration statement as required
in Sections 131.13 and 131.14, the notification as
required by Sections 131.16, 131.20a, or 141.4, or an
agreement or transaction required by Sections 124.2(2),
141, 141a, or 141.1, $200.
(dd) For filing an application for licensing of:
(i) a religious or charitable risk pooling trust
or a workers' compensation pool, $1,000;
(ii) a workers' compensation service company,
$500;
(iii) a self-insured automobile fleet, $200; or
(iv) a renewal of or amendment of any license
issued pursuant to (i), (ii), or (iii) above, $100.
(ee) For filing articles of incorporation for a
syndicate to engage in the business of insurance through
the Illinois Insurance Exchange, $2,000.
(ff) For filing amended articles of incorporation for
a syndicate engaged in the business of insurance through
the Illinois Insurance Exchange, $100.
(gg) For filing articles of incorporation for a
limited syndicate to join with other subscribers or
limited syndicates to do business through the Illinois

HB5493 Engrossed - 73 - LRB103 39189 RPS 69335 b
Insurance Exchange, $1,000.
(hh) For filing amended articles of incorporation for
a limited syndicate to do business through the Illinois
Insurance Exchange, $100.
(ii) For a permit to solicit subscriptions to a
syndicate or limited syndicate, $100.
(jj) For the filing of each form as required in
Section 143 of this Code, $50 per form. Informational and
advertising filings shall be $25 per filing. The fee for
advisory and rating organizations shall be $200 per form.
(i) For the purposes of the form filing fee,
filings made on insert page basis will be considered
one form at the time of its original submission.
Changes made to a form subsequent to its approval
shall be considered a new filing.
(ii) Only one fee shall be charged for a form,
regardless of the number of other forms or policies
with which it will be used.
(iii) Fees charged for a policy filed as it will be
issued regardless of the number of forms comprising
that policy shall not exceed $1,500. For advisory or
rating organizations, fees charged for a policy filed
as it will be issued regardless of the number of forms
comprising that policy shall not exceed $2,500.
(iv) The Director may by rule exempt forms from
such fees.

HB5493 Engrossed - 74 - LRB103 39189 RPS 69335 b
(kk) For filing an application for licensing of a
reinsurance intermediary, $500.
(ll) For filing an application for renewal of a
license of a reinsurance intermediary, $200.
(mm) For filing a plan of division of a domestic stock
company under Article IIB, $100,000 $10,000.
(nn) For filing all documents submitted by a foreign
or alien company to be a certified reinsurer in this
State, except for a fraternal benefit society, $1,000.
(oo) For filing a renewal by a foreign or alien
company to be a certified reinsurer in this State, except
for a fraternal benefit society, $400.
(pp) For filing all documents submitted by a reinsurer
domiciled in a reciprocal jurisdiction, $1,000.
(qq) For filing a renewal by a reinsurer domiciled in
a reciprocal jurisdiction, $400.
(rr) For registering a captive management company or
renewal thereof, $50.
(ss) For filing an insurance business transfer plan
under Article XLVII, $100,000 $25,000.
(2) When printed copies or numerous copies of the same
paper or records are furnished or certified, the Director may
reduce such fees for copies if he finds them excessive. He may,
when he considers it in the public interest, furnish without
charge to state insurance departments and persons other than
companies, copies or certified copies of reports of

HB5493 Engrossed - 75 - LRB103 39189 RPS 69335 b
examinations and of other papers and records.
(3) The expenses incurred in any performance examination
authorized by law shall be paid by the company or person being
examined. The charge shall be reasonably related to the cost
of the examination including but not limited to compensation
of examiners, electronic data processing costs, supervision
and preparation of an examination report and lodging and
travel expenses. All lodging and travel expenses shall be in
accord with the applicable travel regulations as published by
the Department of Central Management Services and approved by
the Governor's Travel Control Board, except that out-of-state
lodging and travel expenses related to examinations authorized
under Section 132 shall be in accordance with travel rates
prescribed under paragraph 301-7.2 of the Federal Travel
Regulations, 41 CFR C.F.R. 301-7.2, for reimbursement of
subsistence expenses incurred during official travel. All
lodging and travel expenses may be reimbursed directly upon
authorization of the Director. With the exception of the
direct reimbursements authorized by the Director, all
performance examination charges collected by the Department
shall be paid to the Insurance Producer Administration Fund,
however, the electronic data processing costs incurred by the
Department in the performance of any examination shall be
billed directly to the company being examined for payment to
the Technology Management Revolving Fund.
(4) At the time of any service of process on the Director

HB5493 Engrossed - 76 - LRB103 39189 RPS 69335 b
as attorney for such service, the Director shall charge and
collect the sum of $40, which may be recovered as taxable costs
by the party to the suit or action causing such service to be
made if he prevails in such suit or action.
(5) (a) The costs incurred by the Department of Insurance
in conducting any hearing authorized by law shall be assessed
against the parties to the hearing in such proportion as the
Director of Insurance may determine upon consideration of all
relevant circumstances including: (1) the nature of the
hearing; (2) whether the hearing was instigated by, or for the
benefit of a particular party or parties; (3) whether there is
a successful party on the merits of the proceeding; and (4) the
relative levels of participation by the parties.
(b) For purposes of this subsection (5) costs incurred
shall mean the hearing officer fees, court reporter fees, and
travel expenses of Department of Insurance officers and
employees; provided however, that costs incurred shall not
include hearing officer fees or court reporter fees unless the
Department has retained the services of independent
contractors or outside experts to perform such functions.
(c) The Director shall make the assessment of costs
incurred as part of the final order or decision arising out of
the proceeding; provided, however, that such order or decision
shall include findings and conclusions in support of the
assessment of costs. This subsection (5) shall not be
construed as permitting the payment of travel expenses unless

HB5493 Engrossed - 77 - LRB103 39189 RPS 69335 b
calculated in accordance with the applicable travel
regulations of the Department of Central Management Services,
as approved by the Governor's Travel Control Board. The
Director as part of such order or decision shall require all
assessments for hearing officer fees and court reporter fees,
if any, to be paid directly to the hearing officer or court
reporter by the party(s) assessed for such costs. The
assessments for travel expenses of Department officers and
employees shall be reimbursable to the Director of Insurance
for deposit to the fund out of which those expenses had been
paid.
(d) The provisions of this subsection (5) shall apply in
the case of any hearing conducted by the Director of Insurance
not otherwise specifically provided for by law.
(6) The Director shall charge and collect an annual
financial regulation fee from every domestic company for
examination and analysis of its financial condition and to
fund the internal costs and expenses of the Interstate
Insurance Receivership Commission as may be allocated to the
State of Illinois and companies doing an insurance business in
this State pursuant to Article X of the Interstate Insurance
Receivership Compact. The fee shall be the greater fixed
amount based upon the combination of nationwide direct premium
income and nationwide reinsurance assumed premium income or
upon admitted assets calculated under this subsection as
follows:

HB5493 Engrossed - 78 - LRB103 39189 RPS 69335 b
(a) Combination of nationwide direct premium income
and nationwide reinsurance assumed premium.
(i) $150, if the premium is less than $500,000 and
there is no reinsurance assumed premium;
(ii) $750, if the premium is $500,000 or more, but
less than $5,000,000 and there is no reinsurance
assumed premium; or if the premium is less than
$5,000,000 and the reinsurance assumed premium is less
than $10,000,000;
(iii) $3,750, if the premium is less than
$5,000,000 and the reinsurance assumed premium is
$10,000,000 or more;
(iv) $7,500, if the premium is $5,000,000 or more,
but less than $10,000,000;
(v) $18,000, if the premium is $10,000,000 or
more, but less than $25,000,000;
(vi) $22,500, if the premium is $25,000,000 or
more, but less than $50,000,000;
(vii) $30,000, if the premium is $50,000,000 or
more, but less than $100,000,000;
(viii) $37,500, if the premium is $100,000,000 or
more.
(b) Admitted assets.
(i) $150, if admitted assets are less than
$1,000,000;
(ii) $750, if admitted assets are $1,000,000 or

HB5493 Engrossed - 79 - LRB103 39189 RPS 69335 b
more, but less than $5,000,000;
(iii) $3,750, if admitted assets are $5,000,000 or
more, but less than $25,000,000;
(iv) $7,500, if admitted assets are $25,000,000 or
more, but less than $50,000,000;
(v) $18,000, if admitted assets are $50,000,000 or
more, but less than $100,000,000;
(vi) $22,500, if admitted assets are $100,000,000
or more, but less than $500,000,000;
(vii) $30,000, if admitted assets are $500,000,000
or more, but less than $1,000,000,000;
(viii) $37,500, if admitted assets are
$1,000,000,000 or more.
(c) The sum of financial regulation fees charged to
the domestic companies of the same affiliated group shall
not exceed $250,000 in the aggregate in any single year
and shall be billed by the Director to the member company
designated by the group.
(7) The Director shall charge and collect an annual
financial regulation fee from every foreign or alien company,
except fraternal benefit societies, for the examination and
analysis of its financial condition and to fund the internal
costs and expenses of the Interstate Insurance Receivership
Commission as may be allocated to the State of Illinois and
companies doing an insurance business in this State pursuant
to Article X of the Interstate Insurance Receivership Compact.

HB5493 Engrossed - 80 - LRB103 39189 RPS 69335 b
The fee shall be a fixed amount based upon Illinois direct
premium income and nationwide reinsurance assumed premium
income in accordance with the following schedule:
(a) $150, if the premium is less than $500,000 and
there is no reinsurance assumed premium;
(b) $750, if the premium is $500,000 or more, but less
than $5,000,000 and there is no reinsurance assumed
premium; or if the premium is less than $5,000,000 and the
reinsurance assumed premium is less than $10,000,000;
(c) $3,750, if the premium is less than $5,000,000 and
the reinsurance assumed premium is $10,000,000 or more;
(d) $7,500, if the premium is $5,000,000 or more, but
less than $10,000,000;
(e) $18,000, if the premium is $10,000,000 or more,
but less than $25,000,000;
(f) $22,500, if the premium is $25,000,000 or more,
but less than $50,000,000;
(g) $30,000, if the premium is $50,000,000 or more,
but less than $100,000,000;
(h) $37,500, if the premium is $100,000,000 or more.
The sum of financial regulation fees under this subsection
(7) charged to the foreign or alien companies within the same
affiliated group shall not exceed $250,000 in the aggregate in
any single year and shall be billed by the Director to the
member company designated by the group.
(8) Beginning January 1, 1992, the financial regulation

HB5493 Engrossed - 81 - LRB103 39189 RPS 69335 b
fees imposed under subsections (6) and (7) of this Section
shall be paid by each company or domestic affiliated group
annually. After January 1, 1994, the fee shall be billed by
Department invoice based upon the company's premium income or
admitted assets as shown in its annual statement for the
preceding calendar year. The invoice is due upon receipt and
must be paid no later than June 30 of each calendar year. All
financial regulation fees collected by the Department shall be
paid to the Insurance Financial Regulation Fund. The
Department may not collect financial examiner per diem charges
from companies subject to subsections (6) and (7) of this
Section undergoing financial examination after June 30, 1992.
(9) In addition to the financial regulation fee required
by this Section, a company undergoing any financial
examination authorized by law shall pay the following costs
and expenses incurred by the Department: electronic data
processing costs, the expenses authorized under Section 131.21
and subsection (d) of Section 132.4 of this Code, and lodging
and travel expenses.
Electronic data processing costs incurred by the
Department in the performance of any examination shall be
billed directly to the company undergoing examination for
payment to the Technology Management Revolving Fund. Except
for direct reimbursements authorized by the Director or direct
payments made under Section 131.21 or subsection (d) of
Section 132.4 of this Code, all financial regulation fees and

HB5493 Engrossed - 82 - LRB103 39189 RPS 69335 b
all financial examination charges collected by the Department
shall be paid to the Insurance Financial Regulation Fund.
All lodging and travel expenses shall be in accordance
with applicable travel regulations published by the Department
of Central Management Services and approved by the Governor's
Travel Control Board, except that out-of-state lodging and
travel expenses related to examinations authorized under
Sections 132.1 through 132.7 shall be in accordance with
travel rates prescribed under paragraph 301-7.2 of the Federal
Travel Regulations, 41 CFR C.F.R. 301-7.2, for reimbursement
of subsistence expenses incurred during official travel. All
lodging and travel expenses may be reimbursed directly upon
the authorization of the Director.
In the case of an organization or person not subject to the
financial regulation fee, the expenses incurred in any
financial examination authorized by law shall be paid by the
organization or person being examined. The charge shall be
reasonably related to the cost of the examination including,
but not limited to, compensation of examiners and other costs
described in this subsection.
(10) Any company, person, or entity failing to make any
payment of $150 or more as required under this Section shall be
subject to the penalty and interest provisions provided for in
subsections (4) and (7) of Section 412.
(11) Unless otherwise specified, all of the fees collected
under this Section shall be paid into the Insurance Financial

HB5493 Engrossed - 83 - LRB103 39189 RPS 69335 b
Regulation Fund.
(12) For purposes of this Section:
(a) "Domestic company" means a company as defined in
Section 2 of this Code which is incorporated or organized
under the laws of this State, and in addition includes a
not-for-profit corporation authorized under the Dental
Service Plan Act or the Voluntary Health Services Plans
Act, a health maintenance organization, and a limited
health service organization.
(b) "Foreign company" means a company as defined in
Section 2 of this Code which is incorporated or organized
under the laws of any state of the United States other than
this State and in addition includes a health maintenance
organization and a limited health service organization
which is incorporated or organized under the laws of any
state of the United States other than this State.
(c) "Alien company" means a company as defined in
Section 2 of this Code which is incorporated or organized
under the laws of any country other than the United
States.
(d) "Fraternal benefit society" means a corporation,
society, order, lodge or voluntary association as defined
in Section 282.1 of this Code.
(e) "Mutual benefit association" means a company,
association or corporation authorized by the Director to
do business in this State under the provisions of Article

HB5493 Engrossed - 84 - LRB103 39189 RPS 69335 b
XVIII of this Code.
(f) "Burial society" means a person, firm,
corporation, society or association of individuals
authorized by the Director to do business in this State
under the provisions of Article XIX of this Code.
(g) "Farm mutual" means a district, county and
township mutual insurance company authorized by the
Director to do business in this State under the provisions
of the Farm Mutual Insurance Company Act of 1986.
(Source: P.A. 102-775, eff. 5-13-22; 103-75, eff. 1-1-25.)
(215 ILCS 5/412) (from Ch. 73, par. 1024)
Sec. 412. Refunds; penalties; collection.
(1)(a) Whenever it appears to the satisfaction of the
Director that because of some mistake of fact, error in
calculation, or erroneous interpretation of a statute of this
or any other state, any authorized company, surplus line
producer, or industrial insured has paid to him, pursuant to
any provision of law, taxes, fees, or other charges in excess
of the amount legally chargeable against it, during the 6-year
6 year period immediately preceding the discovery of such
overpayment, he shall have power to refund to such company,
surplus line producer, or industrial insured the amount of the
excess or excesses by applying the amount or amounts thereof
toward the payment of taxes, fees, or other charges already
due, or which may thereafter become due from that company

HB5493 Engrossed - 85 - LRB103 39189 RPS 69335 b
until such excess or excesses have been fully refunded, or
upon a written request from the authorized company, surplus
line producer, or industrial insured, the Director shall
provide a cash refund within 120 days after receipt of the
written request if all necessary information has been filed
with the Department in order for it to perform an audit of the
tax report for the transaction or period or annual return for
the year in which the overpayment occurred or within 120 days
after the date the Department receives all the necessary
information to perform such audit. The Director shall not
provide a cash refund if there are insufficient funds in the
Insurance Premium Tax Refund Fund to provide a cash refund, if
the amount of the overpayment is less than $100, or if the
amount of the overpayment can be fully offset against the
taxpayer's estimated liability for the year following the year
of the cash refund request. Any cash refund shall be paid from
the Insurance Premium Tax Refund Fund, a special fund hereby
created in the State treasury.
(b) As determined by the Director pursuant to paragraph
(a) of this subsection, the Department shall deposit an amount
of cash refunds approved by the Director for payment as a
result of overpayment of tax liability collected under
Sections 121-2.08, 409, 444, 444.1, and 445 of this Code into
the Insurance Premium Tax Refund Fund.
(c) Beginning July 1, 1999, moneys in the Insurance
Premium Tax Refund Fund shall be expended exclusively for the

HB5493 Engrossed - 86 - LRB103 39189 RPS 69335 b
purpose of paying cash refunds resulting from overpayment of
tax liability under Sections 121-2.08, 409, 444, 444.1, and
445 of this Code as determined by the Director pursuant to
subsection 1(a) of this Section. Cash refunds made in
accordance with this Section may be made from the Insurance
Premium Tax Refund Fund only to the extent that amounts have
been deposited and retained in the Insurance Premium Tax
Refund Fund.
(d) This Section shall constitute an irrevocable and
continuing appropriation from the Insurance Premium Tax Refund
Fund for the purpose of paying cash refunds pursuant to the
provisions of this Section.
(2)(a) When any insurance company fails to file any tax
return required under Sections 408.1, 409, 444, and 444.1 of
this Code or Section 12 of the Fire Investigation Act on the
date prescribed, including any extensions, there shall be
added as a penalty $400 or 10% of the amount of such tax,
whichever is greater, for each month or part of a month of
failure to file, the entire penalty not to exceed $2,000 or 50%
of the tax due, whichever is greater. In this paragraph, "tax
due" means the full amount due for the applicable tax period
under Section 408.1, 409, 444, or 444.1 of this Code or Section
12 of the Fire Investigation Act.
(b) When any industrial insured or surplus line producer
fails to file any tax return or report required under Sections
121-2.08 and 445 of this Code or Section 12 of the Fire

HB5493 Engrossed - 87 - LRB103 39189 RPS 69335 b
Investigation Act on the date prescribed, including any
extensions, there shall be added:
(i) as a late fee, if the return or report is received
at least one day but not more than 15 days after the
prescribed due date, $50 or 5% of the tax due, whichever is
greater, the entire fee not to exceed $1,000;
(ii) as a late fee, if the return or report is received
at least 16 days but not more than 30 days after the
prescribed due date, $100 or 5% of the tax due, whichever
is greater, the entire fee not to exceed $2,000; or
(iii) as a penalty, if the return or report is
received more than 30 days after the prescribed due date,
$100 or 5% of the tax due, whichever is greater, for each
month or part of a month of failure to file, the entire
penalty not to exceed $500 or 30% of the tax due, whichever
is greater.
In this paragraph, "tax due" means the full amount due for
the applicable tax period under Section 121-2.08 or 445 of
this Code or Section 12 of the Fire Investigation Act. A tax
return or report shall be deemed received as of the date mailed
as evidenced by a postmark, proof of mailing on a recognized
United States Postal Service form or a form acceptable to the
United States Postal Service or other commercial mail delivery
service, or other evidence acceptable to the Director.
(3)(a) When any insurance company fails to pay the full
amount due under the provisions of this Section, Sections

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408.1, 409, 444, or 444.1 of this Code, or Section 12 of the
Fire Investigation Act, there shall be added to the amount due
as a penalty an amount equal to 10% of the deficiency.
(a-5) When any industrial insured or surplus line producer
fails to pay the full amount due under the provisions of this
Section, Sections 121-2.08 or 445 of this Code, or Section 12
of the Fire Investigation Act on the date prescribed, there
shall be added:
(i) as a late fee, if the payment is received at least
one day but not more than 7 days after the prescribed due
date, 10% of the tax due, the entire fee not to exceed
$1,000;
(ii) as a late fee, if the payment is received at least
8 days but not more than 14 days after the prescribed due
date, 10% of the tax due, the entire fee not to exceed
$1,500;
(iii) as a late fee, if the payment is received at
least 15 days but not more than 21 days after the
prescribed due date, 10% of the tax due, the entire fee not
to exceed $2,000; or
(iv) as a penalty, if the return or report is received
more than 21 days after the prescribed due date, 10% of the
tax due.
In this paragraph, "tax due" means the full amount due for
the applicable tax period under this Section, Section 121-2.08
or 445 of this Code, or Section 12 of the Fire Investigation

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Act. A tax payment shall be deemed received as of the date
mailed as evidenced by a postmark, proof of mailing on a
recognized United States Postal Service form or a form
acceptable to the United States Postal Service or other
commercial mail delivery service, or other evidence acceptable
to the Director.
(b) If such failure to pay is determined by the Director to
be willful wilful, after a hearing under Sections 402 and 403,
there shall be added to the tax as a penalty an amount equal to
the greater of 50% of the deficiency or 10% of the amount due
and unpaid for each month or part of a month that the
deficiency remains unpaid commencing with the date that the
amount becomes due. Such amount shall be in lieu of any
determined under paragraph (a) or (a-5).
(4) Any insurance company, industrial insured, or surplus
line producer that fails to pay the full amount due under this
Section or Sections 121-2.08, 408.1, 409, 444, 444.1, or 445
of this Code, or Section 12 of the Fire Investigation Act is
liable, in addition to the tax and any late fees and penalties,
for interest on such deficiency at the rate of 12% per annum,
or at such higher adjusted rates as are or may be established
under subsection (b) of Section 6621 of the Internal Revenue
Code, from the date that payment of any such tax was due,
determined without regard to any extensions, to the date of
payment of such amount.
(5) The Director, through the Attorney General, may

HB5493 Engrossed - 90 - LRB103 39189 RPS 69335 b
institute an action in the name of the People of the State of
Illinois, in any court of competent jurisdiction, for the
recovery of the amount of such taxes, fees, and penalties due,
and prosecute the same to final judgment, and take such steps
as are necessary to collect the same.
(6) In the event that the certificate of authority of a
foreign or alien company is revoked for any cause or the
company withdraws from this State prior to the renewal date of
the certificate of authority as provided in Section 114, the
company may recover the amount of any such tax paid in advance.
Except as provided in this subsection, no revocation or
withdrawal excuses payment of or constitutes grounds for the
recovery of any taxes or penalties imposed by this Code.
(7) When an insurance company or domestic affiliated group
fails to pay the full amount of any fee of $200 or more due
under Section 408 of this Code, there shall be added to the
amount due as a penalty the greater of $100 or an amount equal
to 10% of the deficiency for each month or part of a month that
the deficiency remains unpaid.
(8) The Department shall have a lien for the taxes, fees,
charges, fines, penalties, interest, other charges, or any
portion thereof, imposed or assessed pursuant to this Code,
upon all the real and personal property of any company or
person to whom the assessment or final order has been issued or
whenever a tax return is filed without payment of the tax or
penalty shown therein to be due, including all such property

HB5493 Engrossed - 91 - LRB103 39189 RPS 69335 b
of the company or person acquired after receipt of the
assessment, issuance of the order, or filing of the return.
The company or person is liable for the filing fee incurred by
the Department for filing the lien and the filing fee incurred
by the Department to file the release of that lien. The filing
fees shall be paid to the Department in addition to payment of
the tax, fee, charge, fine, penalty, interest, other charges,
or any portion thereof, included in the amount of the lien.
However, where the lien arises because of the issuance of a
final order of the Director or tax assessment by the
Department, the lien shall not attach and the notice referred
to in this Section shall not be filed until all administrative
proceedings or proceedings in court for review of the final
order or assessment have terminated or the time for the taking
thereof has expired without such proceedings being instituted.
Upon the granting of Department review after a lien has
attached, the lien shall remain in full force except to the
extent to which the final assessment may be reduced by a
revised final assessment following the rehearing or review.
The lien created by the issuance of a final assessment shall
terminate, unless a notice of lien is filed, within 3 years
after the date all proceedings in court for the review of the
final assessment have terminated or the time for the taking
thereof has expired without such proceedings being instituted,
or (in the case of a revised final assessment issued pursuant
to a rehearing or review by the Department) within 3 years

HB5493 Engrossed - 92 - LRB103 39189 RPS 69335 b
after the date all proceedings in court for the review of such
revised final assessment have terminated or the time for the
taking thereof has expired without such proceedings being
instituted. Where the lien results from the filing of a tax
return without payment of the tax or penalty shown therein to
be due, the lien shall terminate, unless a notice of lien is
filed, within 3 years after the date when the return is filed
with the Department.
The time limitation period on the Department's right to
file a notice of lien shall not run during any period of time
in which the order of any court has the effect of enjoining or
restraining the Department from filing such notice of lien. If
the Department finds that a company or person is about to
depart from the State, to conceal himself or his property, or
to do any other act tending to prejudice or to render wholly or
partly ineffectual proceedings to collect the amount due and
owing to the Department unless such proceedings are brought
without delay, or if the Department finds that the collection
of the amount due from any company or person will be
jeopardized by delay, the Department shall give the company or
person notice of such findings and shall make demand for
immediate return and payment of the amount, whereupon the
amount shall become immediately due and payable. If the
company or person, within 5 days after the notice (or within
such extension of time as the Department may grant), does not
comply with the notice or show to the Department that the

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findings in the notice are erroneous, the Department may file
a notice of jeopardy assessment lien in the office of the
recorder of the county in which any property of the company or
person may be located and shall notify the company or person of
the filing. The jeopardy assessment lien shall have the same
scope and effect as the statutory lien provided for in this
Section. If the company or person believes that the company or
person does not owe some or all of the tax for which the
jeopardy assessment lien against the company or person has
been filed, or that no jeopardy to the revenue in fact exists,
the company or person may protest within 20 days after being
notified by the Department of the filing of the jeopardy
assessment lien and request a hearing, whereupon the
Department shall hold a hearing in conformity with the
provisions of this Code and, pursuant thereto, shall notify
the company or person of its findings as to whether or not the
jeopardy assessment lien will be released. If not, and if the
company or person is aggrieved by this decision, the company
or person may file an action for judicial review of the final
determination of the Department in accordance with the
Administrative Review Law. If, pursuant to such hearing (or
after an independent determination of the facts by the
Department without a hearing), the Department determines that
some or all of the amount due covered by the jeopardy
assessment lien is not owed by the company or person, or that
no jeopardy to the revenue exists, or if on judicial review the

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final judgment of the court is that the company or person does
not owe some or all of the amount due covered by the jeopardy
assessment lien against them, or that no jeopardy to the
revenue exists, the Department shall release its jeopardy
assessment lien to the extent of such finding of nonliability
for the amount, or to the extent of such finding of no jeopardy
to the revenue. The Department shall also release its jeopardy
assessment lien against the company or person whenever the
amount due and owing covered by the lien, plus any interest
which may be due, are paid and the company or person has paid
the Department in cash or by guaranteed remittance an amount
representing the filing fee for the lien and the filing fee for
the release of that lien. The Department shall file that
release of lien with the recorder of the county where that lien
was filed.
Nothing in this Section shall be construed to give the
Department a preference over the rights of any bona fide
purchaser, holder of a security interest, mechanics
lienholder, mortgagee, or judgment lien creditor arising prior
to the filing of a regular notice of lien or a notice of
jeopardy assessment lien in the office of the recorder in the
county in which the property subject to the lien is located.
For purposes of this Section, "bona fide" shall not include
any mortgage of real or personal property or any other credit
transaction that results in the mortgagee or the holder of the
security acting as trustee for unsecured creditors of the

HB5493 Engrossed - 95 - LRB103 39189 RPS 69335 b
company or person mentioned in the notice of lien who executed
such chattel or real property mortgage or the document
evidencing such credit transaction. The lien shall be inferior
to the lien of general taxes, special assessments, and special
taxes levied by any political subdivision of this State. In
case title to land to be affected by the notice of lien or
notice of jeopardy assessment lien is registered under the
provisions of the Registered Titles (Torrens) Act, such notice
shall be filed in the office of the Registrar of Titles of the
county within which the property subject to the lien is
situated and shall be entered upon the register of titles as a
memorial or charge upon each folium of the register of titles
affected by such notice, and the Department shall not have a
preference over the rights of any bona fide purchaser,
mortgagee, judgment creditor, or other lienholder arising
prior to the registration of such notice. The regular lien or
jeopardy assessment lien shall not be effective against any
purchaser with respect to any item in a retailer's stock in
trade purchased from the retailer in the usual course of the
retailer's business.
(Source: P.A. 102-775, eff. 5-13-22; 103-426, eff. 8-4-23.)
(215 ILCS 5/531.03) (from Ch. 73, par. 1065.80-3)
Sec. 531.03. Coverage and limitations.
(1) This Article shall provide coverage for the policies
and contracts specified in subsection (2) of this Section:

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(a) to persons who, regardless of where they reside
(except for non-resident certificate holders under group
policies or contracts), are the beneficiaries, assignees
or payees, including health care providers rendering
services covered under a health insurance policy or
certificate, of the persons covered under paragraph (b) of
this subsection, and
(b) to persons who are owners of or certificate
holders or enrollees under the policies or contracts
(other than unallocated annuity contracts and structured
settlement annuities) and in each case who:
(i) are residents; or
(ii) are not residents, but only under all of the
following conditions:
(A) the member insurer that issued the
policies or contracts is domiciled in this State;
(B) the states in which the persons reside
have associations similar to the Association
created by this Article;
(C) the persons are not eligible for coverage
by an association in any other state due to the
fact that the insurer or health maintenance
organization was not licensed in that state at the
time specified in that state's guaranty
association law.
(c) For unallocated annuity contracts specified in

HB5493 Engrossed - 97 - LRB103 39189 RPS 69335 b
subsection (2), paragraphs (a) and (b) of this subsection
(1) shall not apply and this Article shall (except as
provided in paragraphs (e) and (f) of this subsection)
provide coverage to:
(i) persons who are the owners of the unallocated
annuity contracts if the contracts are issued to or in
connection with a specific benefit plan whose plan
sponsor has its principal place of business in this
State; and
(ii) persons who are owners of unallocated annuity
contracts issued to or in connection with government
lotteries if the owners are residents.
(d) For structured settlement annuities specified in
subsection (2), paragraphs (a) and (b) of this subsection
(1) shall not apply and this Article shall (except as
provided in paragraphs (e) and (f) of this subsection)
provide coverage to a person who is a payee under a
structured settlement annuity (or beneficiary of a payee
if the payee is deceased), if the payee:
(i) is a resident, regardless of where the
contract owner resides; or
(ii) is not a resident, but only under both of the
following conditions:
(A) with regard to residency:
(I) the contract owner of the structured
settlement annuity is a resident; or

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(II) the contract owner of the structured
settlement annuity is not a resident but the
insurer that issued the structured settlement
annuity is domiciled in this State and the
state in which the contract owner resides has
an association similar to the Association
created by this Article; and
(B) neither the payee or beneficiary nor the
contract owner is eligible for coverage by the
association of the state in which the payee or
contract owner resides.
(e) This Article shall not provide coverage to:
(i) a person who is a payee or beneficiary of a
contract owner resident of this State if the payee or
beneficiary is afforded any coverage by the
association of another state; or
(ii) a person covered under paragraph (c) of this
subsection (1), if any coverage is provided by the
association of another state to that person.
(f) This Article is intended to provide coverage to a
person who is a resident of this State and, in special
circumstances, to a nonresident. In order to avoid
duplicate coverage, if a person who would otherwise
receive coverage under this Article is provided coverage
under the laws of any other state, then the person shall
not be provided coverage under this Article. In

HB5493 Engrossed - 99 - LRB103 39189 RPS 69335 b
determining the application of the provisions of this
paragraph in situations where a person could be covered by
the association of more than one state, whether as an
owner, payee, enrollee, beneficiary, or assignee, this
Article shall be construed in conjunction with other state
laws to result in coverage by only one association.
(2)(a) This Article shall provide coverage to the persons
specified in subsection (1) of this Section for policies or
contracts of direct, (i) nongroup life insurance, health
insurance (that, for the purposes of this Article, includes
health maintenance organization subscriber contracts and
certificates), annuities and supplemental contracts to any of
these, (ii) for certificates under direct group policies or
contracts, (iii) for unallocated annuity contracts and (iv)
for contracts to furnish health care services and subscription
certificates for medical or health care services issued by
persons licensed to transact insurance business in this State
under this Code. Annuity contracts and certificates under
group annuity contracts include but are not limited to
guaranteed investment contracts, deposit administration
contracts, unallocated funding agreements, allocated funding
agreements, structured settlement agreements, lottery
contracts and any immediate or deferred annuity contracts.
(b) Except as otherwise provided in paragraph (c) of this
subsection, this Article shall not provide coverage for:
(i) that portion of a policy or contract not

HB5493 Engrossed - 100 - LRB103 39189 RPS 69335 b
guaranteed by the member insurer, or under which the risk
is borne by the policy or contract owner;
(ii) any such policy or contract or part thereof
assumed by the impaired or insolvent insurer under a
contract of reinsurance, other than reinsurance for which
assumption certificates have been issued;
(iii) any portion of a policy or contract to the
extent that the rate of interest on which it is based or
the interest rate, crediting rate, or similar factor is
determined by use of an index or other external reference
stated in the policy or contract employed in calculating
returns or changes in value:
(A) averaged over the period of 4 years prior to
the date on which the member insurer becomes an
impaired or insolvent insurer under this Article,
whichever is earlier, exceeds the rate of interest
determined by subtracting 2 percentage points from
Moody's Corporate Bond Yield Average averaged for that
same 4-year period or for such lesser period if the
policy or contract was issued less than 4 years before
the member insurer becomes an impaired or insolvent
insurer under this Article, whichever is earlier; and
(B) on and after the date on which the member
insurer becomes an impaired or insolvent insurer under
this Article, whichever is earlier, exceeds the rate
of interest determined by subtracting 3 percentage

HB5493 Engrossed - 101 - LRB103 39189 RPS 69335 b
points from Moody's Corporate Bond Yield Average as
most recently available;
(iv) any unallocated annuity contract issued to or in
connection with a benefit plan protected under the federal
Pension Benefit Guaranty Corporation, regardless of
whether the federal Pension Benefit Guaranty Corporation
has yet become liable to make any payments with respect to
the benefit plan;
(v) any portion of any unallocated annuity contract
which is not issued to or in connection with a specific
employee, union or association of natural persons benefit
plan or a government lottery;
(vi) an obligation that does not arise under the
express written terms of the policy or contract issued by
the member insurer to the enrollee, certificate holder,
contract owner, or policy owner, including without
limitation:
(A) a claim based on marketing materials;
(B) a claim based on side letters, riders, or
other documents that were issued by the member insurer
without meeting applicable policy or contract form
filing or approval requirements;
(C) a misrepresentation of or regarding policy or
contract benefits;
(D) an extra-contractual claim; or
(E) a claim for penalties or consequential or

HB5493 Engrossed - 102 - LRB103 39189 RPS 69335 b
incidental damages;
(vii) any stop-loss insurance, as defined in clause
(b) of Class 1 or clause (a) of Class 2 of Section 4, and
further defined in subsection (d) of Section 352;
(viii) any policy or contract providing any hospital,
medical, prescription drug, or other health care benefits
pursuant to Part C or Part D of Subchapter XVIII, Chapter 7
of Title 42 of the United States Code (commonly known as
Medicare Part C & D), Subchapter XIX, Chapter 7 of Title 42
of the United States Code (commonly known as Medicaid), or
any regulations issued pursuant thereto;
(ix) any portion of a policy or contract to the extent
that the assessments required by Section 531.09 of this
Code with respect to the policy or contract are preempted
or otherwise not permitted by federal or State law;
(x) any portion of a policy or contract issued to a
plan or program of an employer, association, or other
person to provide life, health, or annuity benefits to its
employees, members, or others to the extent that the plan
or program is self-funded or uninsured, including, but not
limited to, benefits payable by an employer, association,
or other person under:
(A) a multiple employer welfare arrangement as
defined in 29 U.S.C. Section 1002;
(B) a minimum premium group insurance plan;
(C) a stop-loss group insurance plan; or

HB5493 Engrossed - 103 - LRB103 39189 RPS 69335 b
(D) an administrative services only contract;
(xi) any portion of a policy or contract to the extent
that it provides for:
(A) dividends or experience rating credits;
(B) voting rights; or
(C) payment of any fees or allowances to any
person, including the policy or contract owner, in
connection with the service to or administration of
the policy or contract;
(xii) any policy or contract issued in this State by a
member insurer at a time when it was not licensed or did
not have a certificate of authority to issue the policy or
contract in this State;
(xiii) any contractual agreement that establishes the
member insurer's obligations to provide a book value
accounting guaranty for defined contribution benefit plan
participants by reference to a portfolio of assets that is
owned by the benefit plan or its trustee, which in each
case is not an affiliate of the member insurer;
(xiv) any portion of a policy or contract to the
extent that it provides for interest or other changes in
value to be determined by the use of an index or other
external reference stated in the policy or contract, but
which have not been credited to the policy or contract, or
as to which the policy or contract owner's rights are
subject to forfeiture, as of the date the member insurer

HB5493 Engrossed - 104 - LRB103 39189 RPS 69335 b
becomes an impaired or insolvent insurer under this Code,
whichever is earlier. If a policy's or contract's interest
or changes in value are credited less frequently than
annually, then for purposes of determining the values that
have been credited and are not subject to forfeiture under
this Section, the interest or change in value determined
by using the procedures defined in the policy or contract
will be credited as if the contractual date of crediting
interest or changing values was the date of impairment or
insolvency, whichever is earlier, and will not be subject
to forfeiture; or
(xv) that portion or part of a variable life insurance
or variable annuity contract not guaranteed by a member
insurer.
(c) The exclusion from coverage referenced in subdivision
(iii) of paragraph (b) of this subsection shall not apply to
any portion of a policy or contract, including a rider, that
provides long-term care or other health insurance benefits.
(3) The benefits for which the Association may become
liable shall in no event exceed the lesser of:
(a) the contractual obligations for which the member
insurer is liable or would have been liable if it were not
an impaired or insolvent insurer, or
(b)(i) with respect to any one life, regardless of the
number of policies or contracts:
(A) $300,000 in life insurance death benefits, but

HB5493 Engrossed - 105 - LRB103 39189 RPS 69335 b
not more than $100,000 in net cash surrender and net
cash withdrawal values for life insurance;
(B) for health insurance benefits:
(I) $100,000 for coverages not defined as
disability income insurance or health benefit
plans or long-term care insurance, including any
net cash surrender and net cash withdrawal values;
(II) $300,000 for disability income insurance
and $300,000 for long-term care insurance; and
(III) $500,000 for health benefit plans;
(C) $250,000 in the present value of annuity
benefits, including net cash surrender and net cash
withdrawal values;
(ii) with respect to each individual participating in
a governmental retirement benefit plan established under
Section 401, 403(b), or 457 of the U.S. Internal Revenue
Code covered by an unallocated annuity contract or the
beneficiaries of each such individual if deceased, in the
aggregate, $250,000 in present value annuity benefits,
including net cash surrender and net cash withdrawal
values;
(iii) with respect to each payee of a structured
settlement annuity or beneficiary or beneficiaries of the
payee if deceased, $250,000 in present value annuity
benefits, in the aggregate, including net cash surrender
and net cash withdrawal values, if any; or

HB5493 Engrossed - 106 - LRB103 39189 RPS 69335 b
(iv) with respect to either (1) one contract owner
provided coverage under subparagraph (ii) of paragraph (c)
of subsection (1) of this Section or (2) one plan sponsor
whose plans own directly or in trust one or more
unallocated annuity contracts not included in subparagraph
(ii) of paragraph (b) of this subsection, $5,000,000 in
benefits, irrespective of the number of contracts with
respect to the contract owner or plan sponsor. However, in
the case where one or more unallocated annuity contracts
are covered contracts under this Article and are owned by
a trust or other entity for the benefit of 2 or more plan
sponsors, coverage shall be afforded by the Association if
the largest interest in the trust or entity owning the
contract or contracts is held by a plan sponsor whose
principal place of business is in this State. In no event
shall the Association be obligated to cover more than
$5,000,000 in benefits with respect to all these
unallocated contracts.
In no event shall the Association be obligated to cover
more than (1) an aggregate of $300,000 in benefits with
respect to any one life under subparagraphs (i), (ii), and
(iii) of this paragraph (b) except with respect to benefits
for health benefit plans under item (B) of subparagraph (i) of
this paragraph (b), in which case the aggregate liability of
the Association shall not exceed $500,000 with respect to any
one individual or (2) with respect to one owner of multiple

HB5493 Engrossed - 107 - LRB103 39189 RPS 69335 b
nongroup policies of life insurance, whether the policy or
contract owner is an individual, firm, corporation, or other
person and whether the persons insured are officers, managers,
employees, or other persons, $5,000,000 in benefits,
regardless of the number of policies and contracts held by the
owner.
The limitations set forth in this subsection are
limitations on the benefits for which the Association is
obligated before taking into account either its subrogation
and assignment rights or the extent to which those benefits
could be provided out of the assets of the impaired or
insolvent insurer attributable to covered policies. The costs
of the Association's obligations under this Article may be met
by the use of assets attributable to covered policies or
reimbursed to the Association pursuant to its subrogation and
assignment rights.
For purposes of this Article, benefits provided by a
long-term care rider to a life insurance policy or annuity
contract shall be considered the same type of benefits as the
base life insurance policy or annuity contract to which it
relates.
(4) In performing its obligations to provide coverage
under Section 531.08 of this Code, the Association shall not
be required to guarantee, assume, reinsure, reissue, or
perform or cause to be guaranteed, assumed, reinsured,
reissued, or performed the contractual obligations of the

HB5493 Engrossed - 108 - LRB103 39189 RPS 69335 b
insolvent or impaired insurer under a covered policy or
contract that do not materially affect the economic values or
economic benefits of the covered policy or contract.
(Source: P.A. 100-687, eff. 8-3-18; 100-863, eff. 8-14-18.)
(215 ILCS 5/356z.30a rep.)
(215 ILCS 5/362a rep.)
Section 26. The Illinois Insurance Code is amended by
repealing Sections 356z.30a and 362a.
Section 30. The Network Adequacy and Transparency Act is
amended by changing Sections 5 and 10 as follows:
(215 ILCS 124/5)
Sec. 5. Definitions. In this Act:
"Authorized representative" means a person to whom a
beneficiary has given express written consent to represent the
beneficiary; a person authorized by law to provide substituted
consent for a beneficiary; or the beneficiary's treating
provider only when the beneficiary or his or her family member
is unable to provide consent.
"Beneficiary" means an individual, an enrollee, an
insured, a participant, or any other person entitled to
reimbursement for covered expenses of or the discounting of
provider fees for health care services under a program in
which the beneficiary has an incentive to utilize the services

HB5493 Engrossed - 109 - LRB103 39189 RPS 69335 b
of a provider that has entered into an agreement or
arrangement with an insurer.
"Department" means the Department of Insurance.
"Director" means the Director of Insurance.
"Family caregiver" means a relative, partner, friend, or
neighbor who has a significant relationship with the patient
and administers or assists the patient with activities of
daily living, instrumental activities of daily living, or
other medical or nursing tasks for the quality and welfare of
that patient.
"Insurer" means any entity that offers individual or group
accident and health insurance, including, but not limited to,
health maintenance organizations, preferred provider
organizations, exclusive provider organizations, and other
plan structures requiring network participation, excluding the
medical assistance program under the Illinois Public Aid Code,
the State employees group health insurance program, workers
compensation insurance, and pharmacy benefit managers.
"Material change" means a significant reduction in the
number of providers available in a network plan, including,
but not limited to, a reduction of 10% or more in a specific
type of providers, the removal of a major health system that
causes a network to be significantly different from the
network when the beneficiary purchased the network plan, or
any change that would cause the network to no longer satisfy
the requirements of this Act or the Department's rules for

HB5493 Engrossed - 110 - LRB103 39189 RPS 69335 b
network adequacy and transparency.
"Network" means the group or groups of preferred providers
providing services to a network plan.
"Network plan" means an individual or group policy of
accident and health insurance that either requires a covered
person to use or creates incentives, including financial
incentives, for a covered person to use providers managed,
owned, under contract with, or employed by the insurer.
"Ongoing course of treatment" means (1) treatment for a
life-threatening condition, which is a disease or condition
for which likelihood of death is probable unless the course of
the disease or condition is interrupted; (2) treatment for a
serious acute condition, defined as a disease or condition
requiring complex ongoing care that the covered person is
currently receiving, such as chemotherapy, radiation therapy,
or post-operative visits; (3) a course of treatment for a
health condition that a treating provider attests that
discontinuing care by that provider would worsen the condition
or interfere with anticipated outcomes; or (4) the third
trimester of pregnancy through the post-partum period.
"Preferred provider" means any provider who has entered,
either directly or indirectly, into an agreement with an
employer or risk-bearing entity relating to health care
services that may be rendered to beneficiaries under a network
plan.
"Providers" means physicians licensed to practice medicine

HB5493 Engrossed - 111 - LRB103 39189 RPS 69335 b
in all its branches, other health care professionals,
hospitals, or other health care institutions that provide
health care services.
"Telehealth" has the meaning given to that term in Section
356z.22 of the Illinois Insurance Code.
"Telemedicine" has the meaning given to that term in
Section 49.5 of the Medical Practice Act of 1987.
"Tiered network" means a network that identifies and
groups some or all types of provider and facilities into
specific groups to which different provider reimbursement,
covered person cost-sharing or provider access requirements,
or any combination thereof, apply for the same services.
"Woman's principal health care provider" means a physician
licensed to practice medicine in all of its branches
specializing in obstetrics, gynecology, or family practice.
(Source: P.A. 102-92, eff. 7-9-21; 102-813, eff. 5-13-22.)
(215 ILCS 124/10)
Sec. 10. Network adequacy.
(a) An insurer providing a network plan shall file a
description of all of the following with the Director:
(1) The written policies and procedures for adding
providers to meet patient needs based on increases in the
number of beneficiaries, changes in the
patient-to-provider ratio, changes in medical and health
care capabilities, and increased demand for services.

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(2) The written policies and procedures for making
referrals within and outside the network.
(3) The written policies and procedures on how the
network plan will provide 24-hour, 7-day per week access
to network-affiliated primary care, emergency services,
and obstetrical and gynecological health care
professionals women's principal health care providers.
An insurer shall not prohibit a preferred provider from
discussing any specific or all treatment options with
beneficiaries irrespective of the insurer's position on those
treatment options or from advocating on behalf of
beneficiaries within the utilization review, grievance, or
appeals processes established by the insurer in accordance
with any rights or remedies available under applicable State
or federal law.
(b) Insurers must file for review a description of the
services to be offered through a network plan. The description
shall include all of the following:
(1) A geographic map of the area proposed to be served
by the plan by county service area and zip code, including
marked locations for preferred providers.
(2) As deemed necessary by the Department, the names,
addresses, phone numbers, and specialties of the providers
who have entered into preferred provider agreements under
the network plan.
(3) The number of beneficiaries anticipated to be

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covered by the network plan.
(4) An Internet website and toll-free telephone number
for beneficiaries and prospective beneficiaries to access
current and accurate lists of preferred providers,
additional information about the plan, as well as any
other information required by Department rule.
(5) A description of how health care services to be
rendered under the network plan are reasonably accessible
and available to beneficiaries. The description shall
address all of the following:
(A) the type of health care services to be
provided by the network plan;
(B) the ratio of physicians and other providers to
beneficiaries, by specialty and including primary care
physicians and facility-based physicians when
applicable under the contract, necessary to meet the
health care needs and service demands of the currently
enrolled population;
(C) the travel and distance standards for plan
beneficiaries in county service areas; and
(D) a description of how the use of telemedicine,
telehealth, or mobile care services may be used to
partially meet the network adequacy standards, if
applicable.
(6) A provision ensuring that whenever a beneficiary
has made a good faith effort, as evidenced by accessing

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the provider directory, calling the network plan, and
calling the provider, to utilize preferred providers for a
covered service and it is determined the insurer does not
have the appropriate preferred providers due to
insufficient number, type, unreasonable travel distance or
delay, or preferred providers refusing to provide a
covered service because it is contrary to the conscience
of the preferred providers, as protected by the Health
Care Right of Conscience Act, the insurer shall ensure,
directly or indirectly, by terms contained in the payer
contract, that the beneficiary will be provided the
covered service at no greater cost to the beneficiary than
if the service had been provided by a preferred provider.
This paragraph (6) does not apply to: (A) a beneficiary
who willfully chooses to access a non-preferred provider
for health care services available through the panel of
preferred providers, or (B) a beneficiary enrolled in a
health maintenance organization. In these circumstances,
the contractual requirements for non-preferred provider
reimbursements shall apply unless Section 356z.3a of the
Illinois Insurance Code requires otherwise. In no event
shall a beneficiary who receives care at a participating
health care facility be required to search for
participating providers under the circumstances described
in subsection (b) or (b-5) of Section 356z.3a of the
Illinois Insurance Code except under the circumstances

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described in paragraph (2) of subsection (b-5).
(7) A provision that the beneficiary shall receive
emergency care coverage such that payment for this
coverage is not dependent upon whether the emergency
services are performed by a preferred or non-preferred
provider and the coverage shall be at the same benefit
level as if the service or treatment had been rendered by a
preferred provider. For purposes of this paragraph (7),
"the same benefit level" means that the beneficiary is
provided the covered service at no greater cost to the
beneficiary than if the service had been provided by a
preferred provider. This provision shall be consistent
with Section 356z.3a of the Illinois Insurance Code.
(8) A limitation that, if the plan provides that the
beneficiary will incur a penalty for failing to
pre-certify inpatient hospital treatment, the penalty may
not exceed $1,000 per occurrence in addition to the plan
cost-sharing cost sharing provisions.
(c) The network plan shall demonstrate to the Director a
minimum ratio of providers to plan beneficiaries as required
by the Department.
(1) The ratio of physicians or other providers to plan
beneficiaries shall be established annually by the
Department in consultation with the Department of Public
Health based upon the guidance from the federal Centers
for Medicare and Medicaid Services. The Department shall

HB5493 Engrossed - 116 - LRB103 39189 RPS 69335 b
not establish ratios for vision or dental providers who
provide services under dental-specific or vision-specific
benefits. The Department shall consider establishing
ratios for the following physicians or other providers:
(A) Primary Care;
(B) Pediatrics;
(C) Cardiology;
(D) Gastroenterology;
(E) General Surgery;
(F) Neurology;
(G) OB/GYN;
(H) Oncology/Radiation;
(I) Ophthalmology;
(J) Urology;
(K) Behavioral Health;
(L) Allergy/Immunology;
(M) Chiropractic;
(N) Dermatology;
(O) Endocrinology;
(P) Ears, Nose, and Throat (ENT)/Otolaryngology;
(Q) Infectious Disease;
(R) Nephrology;
(S) Neurosurgery;
(T) Orthopedic Surgery;
(U) Physiatry/Rehabilitative;
(V) Plastic Surgery;

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(W) Pulmonary;
(X) Rheumatology;
(Y) Anesthesiology;
(Z) Pain Medicine;
(AA) Pediatric Specialty Services;
(BB) Outpatient Dialysis; and
(CC) HIV.
(2) The Director shall establish a process for the
review of the adequacy of these standards, along with an
assessment of additional specialties to be included in the
list under this subsection (c).
(d) The network plan shall demonstrate to the Director
maximum travel and distance standards for plan beneficiaries,
which shall be established annually by the Department in
consultation with the Department of Public Health based upon
the guidance from the federal Centers for Medicare and
Medicaid Services. These standards shall consist of the
maximum minutes or miles to be traveled by a plan beneficiary
for each county type, such as large counties, metro counties,
or rural counties as defined by Department rule.
The maximum travel time and distance standards must
include standards for each physician and other provider
category listed for which ratios have been established.
The Director shall establish a process for the review of
the adequacy of these standards along with an assessment of
additional specialties to be included in the list under this

HB5493 Engrossed - 118 - LRB103 39189 RPS 69335 b
subsection (d).
(d-5)(1) Every insurer shall ensure that beneficiaries
have timely and proximate access to treatment for mental,
emotional, nervous, or substance use disorders or conditions
in accordance with the provisions of paragraph (4) of
subsection (a) of Section 370c of the Illinois Insurance Code.
Insurers shall use a comparable process, strategy, evidentiary
standard, and other factors in the development and application
of the network adequacy standards for timely and proximate
access to treatment for mental, emotional, nervous, or
substance use disorders or conditions and those for the access
to treatment for medical and surgical conditions. As such, the
network adequacy standards for timely and proximate access
shall equally be applied to treatment facilities and providers
for mental, emotional, nervous, or substance use disorders or
conditions and specialists providing medical or surgical
benefits pursuant to the parity requirements of Section 370c.1
of the Illinois Insurance Code and the federal Paul Wellstone
and Pete Domenici Mental Health Parity and Addiction Equity
Act of 2008. Notwithstanding the foregoing, the network
adequacy standards for timely and proximate access to
treatment for mental, emotional, nervous, or substance use
disorders or conditions shall, at a minimum, satisfy the
following requirements:
(A) For beneficiaries residing in the metropolitan
counties of Cook, DuPage, Kane, Lake, McHenry, and Will,

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network adequacy standards for timely and proximate access
to treatment for mental, emotional, nervous, or substance
use disorders or conditions means a beneficiary shall not
have to travel longer than 30 minutes or 30 miles from the
beneficiary's residence to receive outpatient treatment
for mental, emotional, nervous, or substance use disorders
or conditions. Beneficiaries shall not be required to wait
longer than 10 business days between requesting an initial
appointment and being seen by the facility or provider of
mental, emotional, nervous, or substance use disorders or
conditions for outpatient treatment or to wait longer than
20 business days between requesting a repeat or follow-up
appointment and being seen by the facility or provider of
mental, emotional, nervous, or substance use disorders or
conditions for outpatient treatment; however, subject to
the protections of paragraph (3) of this subsection, a
network plan shall not be held responsible if the
beneficiary or provider voluntarily chooses to schedule an
appointment outside of these required time frames.
(B) For beneficiaries residing in Illinois counties
other than those counties listed in subparagraph (A) of
this paragraph, network adequacy standards for timely and
proximate access to treatment for mental, emotional,
nervous, or substance use disorders or conditions means a
beneficiary shall not have to travel longer than 60
minutes or 60 miles from the beneficiary's residence to

HB5493 Engrossed - 120 - LRB103 39189 RPS 69335 b
receive outpatient treatment for mental, emotional,
nervous, or substance use disorders or conditions.
Beneficiaries shall not be required to wait longer than 10
business days between requesting an initial appointment
and being seen by the facility or provider of mental,
emotional, nervous, or substance use disorders or
conditions for outpatient treatment or to wait longer than
20 business days between requesting a repeat or follow-up
appointment and being seen by the facility or provider of
mental, emotional, nervous, or substance use disorders or
conditions for outpatient treatment; however, subject to
the protections of paragraph (3) of this subsection, a
network plan shall not be held responsible if the
beneficiary or provider voluntarily chooses to schedule an
appointment outside of these required time frames.
(2) For beneficiaries residing in all Illinois counties,
network adequacy standards for timely and proximate access to
treatment for mental, emotional, nervous, or substance use
disorders or conditions means a beneficiary shall not have to
travel longer than 60 minutes or 60 miles from the
beneficiary's residence to receive inpatient or residential
treatment for mental, emotional, nervous, or substance use
disorders or conditions.
(3) If there is no in-network facility or provider
available for a beneficiary to receive timely and proximate
access to treatment for mental, emotional, nervous, or

HB5493 Engrossed - 121 - LRB103 39189 RPS 69335 b
substance use disorders or conditions in accordance with the
network adequacy standards outlined in this subsection, the
insurer shall provide necessary exceptions to its network to
ensure admission and treatment with a provider or at a
treatment facility in accordance with the network adequacy
standards in this subsection.
(e) Except for network plans solely offered as a group
health plan, these ratio and time and distance standards apply
to the lowest cost-sharing tier of any tiered network.
(f) The network plan may consider use of other health care
service delivery options, such as telemedicine or telehealth,
mobile clinics, and centers of excellence, or other ways of
delivering care to partially meet the requirements set under
this Section.
(g) Except for the requirements set forth in subsection
(d-5), insurers who are not able to comply with the provider
ratios and time and distance standards established by the
Department may request an exception to these requirements from
the Department. The Department may grant an exception in the
following circumstances:
(1) if no providers or facilities meet the specific
time and distance standard in a specific service area and
the insurer (i) discloses information on the distance and
travel time points that beneficiaries would have to travel
beyond the required criterion to reach the next closest
contracted provider outside of the service area and (ii)

HB5493 Engrossed - 122 - LRB103 39189 RPS 69335 b
provides contact information, including names, addresses,
and phone numbers for the next closest contracted provider
or facility;
(2) if patterns of care in the service area do not
support the need for the requested number of provider or
facility type and the insurer provides data on local
patterns of care, such as claims data, referral patterns,
or local provider interviews, indicating where the
beneficiaries currently seek this type of care or where
the physicians currently refer beneficiaries, or both; or
(3) other circumstances deemed appropriate by the
Department consistent with the requirements of this Act.
(h) Insurers are required to report to the Director any
material change to an approved network plan within 15 days
after the change occurs and any change that would result in
failure to meet the requirements of this Act. Upon notice from
the insurer, the Director shall reevaluate the network plan's
compliance with the network adequacy and transparency
standards of this Act.
(Source: P.A. 102-144, eff. 1-1-22; 102-901, eff. 7-1-22;
102-1117, eff. 1-13-23.)
Section 35. The Health Maintenance Organization Act is
amended by changing Sections 4.5-1, 5-3, and 5-3.1 as follows:
(215 ILCS 125/4.5-1)

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Sec. 4.5-1. Point-of-service health service contracts.
(a) A health maintenance organization that offers a
point-of-service contract:
(1) must include as in-plan covered services all
services required by law to be provided by a health
maintenance organization;
(2) must provide incentives, which shall include
financial incentives, for enrollees to use in-plan covered
services;
(3) may not offer services out-of-plan without
providing those services on an in-plan basis;
(4) may include annual out-of-pocket limits and
lifetime maximum benefits allowances for out-of-plan
services that are separate from any limits or allowances
applied to in-plan services;
(5) may not consider emergency services, authorized
referral services, or non-routine services obtained out of
the service area to be point-of-service services;
(6) may treat as out-of-plan services those services
that an enrollee obtains from a participating provider,
but for which the proper authorization was not given by
the health maintenance organization; and
(7) after January 1, 2003 (the effective date of
Public Act 92-579), must include the following disclosure
on its point-of-service contracts and evidences of
coverage: "WARNING, LIMITED BENEFITS WILL BE PAID WHEN

HB5493 Engrossed - 124 - LRB103 39189 RPS 69335 b
NON-PARTICIPATING PROVIDERS ARE USED. YOU CAN EXPECT TO
PAY MORE THAN THE COST-SHARING AMOUNT DEFINED IN THE
POLICY IN NON-EMERGENCY SITUATIONS. Except in limited
situations governed by the federal No Surprises Act or
Section 356z.3a of the Illinois Insurance Code (215 ILCS
5/356z.3a), non-participating providers furnishing
non-emergency services may bill members for any amount up
to the billed charge after the plan has paid its portion of
the bill. If you elect to use a non-participating
provider, plan benefit payments will be determined
according to your policy's fee schedule, usual and
customary charge (which is determined by comparing charges
for similar services adjusted to the geographical area
where the services are performed), or other method as
defined by the policy. Participating providers have agreed
to ONLY bill members the cost-sharing amounts. You should
be aware that when you elect to utilize the services of a
non-participating provider for a covered service in
non-emergency situations, benefit payments to such
non-participating provider are not based upon the amount
billed. The basis of your benefit payment will be
determined according to your policy's fee schedule, usual
and customary charge (which is determined by comparing
charges for similar services adjusted to the geographical
area where the services are performed), or other method as
defined by the policy. YOU CAN EXPECT TO PAY MORE THAN THE

HB5493 Engrossed - 125 - LRB103 39189 RPS 69335 b
COINSURANCE AMOUNT DEFINED IN THE POLICY AFTER THE PLAN
HAS PAID ITS REQUIRED PORTION. Non-participating providers
may bill members for any amount up to the billed charge
after the plan has paid its portion of the bill, except as
provided in Section 356z.3a of the Illinois Insurance Code
for covered services received at a participating health
care facility from a non-participating provider that are:
(a) ancillary services, (b) items or services furnished as
a result of unforeseen, urgent medical needs that arise at
the time the item or service is furnished, or (c) items or
services received when the facility or the
non-participating provider fails to satisfy the notice and
consent criteria specified under Section 356z.3a.
Participating providers have agreed to accept discounted
payments for services with no additional billing to the
member other than co-insurance and deductible amounts. You
may obtain further information about the participating
status of professional providers and information on
out-of-pocket expenses by calling the toll-free toll free
telephone number on your identification card.".
(b) A health maintenance organization offering a
point-of-service contract is subject to all of the following
limitations:
(1) The health maintenance organization may not expend
in any calendar quarter more than 20% of its total
expenditures for all its members for out-of-plan covered

HB5493 Engrossed - 126 - LRB103 39189 RPS 69335 b
services.
(2) If the amount specified in item (1) of this
subsection is exceeded by 2% in a quarter, the health
maintenance organization must effect compliance with item
(1) of this subsection by the end of the following
quarter.
(3) If compliance with the amount specified in item
(1) of this subsection is not demonstrated in the health
maintenance organization's next quarterly report, the
health maintenance organization may not offer the
point-of-service contract to new groups or include the
point-of-service option in the renewal of an existing
group until compliance with the amount specified in item
(1) of this subsection is demonstrated or until otherwise
allowed by the Director.
(4) A health maintenance organization failing, without
just cause, to comply with the provisions of this
subsection shall be required, after notice and hearing, to
pay a penalty of $250 for each day out of compliance, to be
recovered by the Director. Any penalty recovered shall be
paid into the General Revenue Fund. The Director may
reduce the penalty if the health maintenance organization
demonstrates to the Director that the imposition of the
penalty would constitute a financial hardship to the
health maintenance organization.
(c) A health maintenance organization that offers a

HB5493 Engrossed - 127 - LRB103 39189 RPS 69335 b
point-of-service product must do all of the following:
(1) File a quarterly financial statement detailing
compliance with the requirements of subsection (b).
(2) Track out-of-plan, point-of-service utilization
separately from in-plan or non-point-of-service,
out-of-plan emergency care, referral care, and urgent care
out of the service area utilization.
(3) Record out-of-plan utilization in a manner that
will permit such utilization and cost reporting as the
Director may, by rule, require.
(4) Demonstrate to the Director's satisfaction that
the health maintenance organization has the fiscal,
administrative, and marketing capacity to control its
point-of-service enrollment, utilization, and costs so as
not to jeopardize the financial security of the health
maintenance organization.
(5) Maintain, in addition to any other deposit
required under this Act, the deposit required by Section
2-6.
(6) Maintain cash and cash equivalents of sufficient
amount to fully liquidate 10 days' average claim payments,
subject to review by the Director.
(7) Maintain and file with the Director, reinsurance
coverage protecting against catastrophic losses on
out-of-network point-of-service services. Deductibles may
not exceed $100,000 per covered life per year, and the

HB5493 Engrossed - 128 - LRB103 39189 RPS 69335 b
portion of risk retained by the health maintenance
organization once deductibles have been satisfied may not
exceed 20%. Reinsurance must be placed with licensed
authorized reinsurers qualified to do business in this
State.
(d) A health maintenance organization may not issue a
point-of-service contract until it has filed and had approved
by the Director a plan to comply with the provisions of this
Section. The compliance plan must, at a minimum, include
provisions demonstrating that the health maintenance
organization will do all of the following:
(1) Design the benefit levels and conditions of
coverage for in-plan covered services and out-of-plan
covered services as required by this Article.
(2) Provide or arrange for the provision of adequate
systems to:
(A) process and pay claims for all out-of-plan
covered services;
(B) meet the requirements for point-of-service
contracts set forth in this Section and any additional
requirements that may be set forth by the Director;
and
(C) generate accurate data and financial and
regulatory reports on a timely basis so that the
Department of Insurance can evaluate the health
maintenance organization's experience with the

HB5493 Engrossed - 129 - LRB103 39189 RPS 69335 b
point-of-service contract and monitor compliance with
point-of-service contract provisions.
(3) Comply with the requirements of subsections (b)
and (c).
(Source: P.A. 102-901, eff. 1-1-23; 103-154, eff. 6-30-23.)
(215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
Sec. 5-3. Insurance Code provisions.
(a) Health Maintenance Organizations shall be subject to
the provisions of Sections 133, 134, 136, 137, 139, 140,
141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49,
355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356v,
356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21, 356z.22,
356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29, 356z.30,
356z.30a, 356z.31, 356z.32, 356z.33, 356z.34, 356z.35,
356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41, 356z.44,
356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50, 356z.51,
356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58, 356z.59,
356z.60, 356z.61, 356z.62, 356z.63, 356z.64, 356z.65, 356z.66,
356z.67, 356z.68, 356z.69, 356z.70, 364, 364.01, 364.3, 367.2,
367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370c, 370c.1,
401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, and
444.1, paragraph (c) of subsection (2) of Section 367, and

HB5493 Engrossed - 130 - LRB103 39189 RPS 69335 b
Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV,
XXVI, and XXXIIB of the Illinois Insurance Code.
(b) For purposes of the Illinois Insurance Code, except
for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
Health Maintenance Organizations in the following categories
are deemed to be "domestic companies":
(1) a corporation authorized under the Dental Service
Plan Act or the Voluntary Health Services Plans Act;
(2) a corporation organized under the laws of this
State; or
(3) a corporation organized under the laws of another
state, 30% or more of the enrollees of which are residents
of this State, except a corporation subject to
substantially the same requirements in its state of
organization as is a "domestic company" under Article VIII
1/2 of the Illinois Insurance Code.
(c) In considering the merger, consolidation, or other
acquisition of control of a Health Maintenance Organization
pursuant to Article VIII 1/2 of the Illinois Insurance Code,
(1) the Director shall give primary consideration to
the continuation of benefits to enrollees and the
financial conditions of the acquired Health Maintenance
Organization after the merger, consolidation, or other
acquisition of control takes effect;
(2)(i) the criteria specified in subsection (1)(b) of
Section 131.8 of the Illinois Insurance Code shall not

HB5493 Engrossed - 131 - LRB103 39189 RPS 69335 b
apply and (ii) the Director, in making his determination
with respect to the merger, consolidation, or other
acquisition of control, need not take into account the
effect on competition of the merger, consolidation, or
other acquisition of control;
(3) the Director shall have the power to require the
following information:
(A) certification by an independent actuary of the
adequacy of the reserves of the Health Maintenance
Organization sought to be acquired;
(B) pro forma financial statements reflecting the
combined balance sheets of the acquiring company and
the Health Maintenance Organization sought to be
acquired as of the end of the preceding year and as of
a date 90 days prior to the acquisition, as well as pro
forma financial statements reflecting projected
combined operation for a period of 2 years;
(C) a pro forma business plan detailing an
acquiring party's plans with respect to the operation
of the Health Maintenance Organization sought to be
acquired for a period of not less than 3 years; and
(D) such other information as the Director shall
require.
(d) The provisions of Article VIII 1/2 of the Illinois
Insurance Code and this Section 5-3 shall apply to the sale by
any health maintenance organization of greater than 10% of its

HB5493 Engrossed - 132 - LRB103 39189 RPS 69335 b
enrollee population (including, without limitation, the health
maintenance organization's right, title, and interest in and
to its health care certificates).
(e) In considering any management contract or service
agreement subject to Section 141.1 of the Illinois Insurance
Code, the Director (i) shall, in addition to the criteria
specified in Section 141.2 of the Illinois Insurance Code,
take into account the effect of the management contract or
service agreement on the continuation of benefits to enrollees
and the financial condition of the health maintenance
organization to be managed or serviced, and (ii) need not take
into account the effect of the management contract or service
agreement on competition.
(f) Except for small employer groups as defined in the
Small Employer Rating, Renewability and Portability Health
Insurance Act and except for medicare supplement policies as
defined in Section 363 of the Illinois Insurance Code, a
Health Maintenance Organization may by contract agree with a
group or other enrollment unit to effect refunds or charge
additional premiums under the following terms and conditions:
(i) the amount of, and other terms and conditions with
respect to, the refund or additional premium are set forth
in the group or enrollment unit contract agreed in advance
of the period for which a refund is to be paid or
additional premium is to be charged (which period shall
not be less than one year); and

HB5493 Engrossed - 133 - LRB103 39189 RPS 69335 b
(ii) the amount of the refund or additional premium
shall not exceed 20% of the Health Maintenance
Organization's profitable or unprofitable experience with
respect to the group or other enrollment unit for the
period (and, for purposes of a refund or additional
premium, the profitable or unprofitable experience shall
be calculated taking into account a pro rata share of the
Health Maintenance Organization's administrative and
marketing expenses, but shall not include any refund to be
made or additional premium to be paid pursuant to this
subsection (f)). The Health Maintenance Organization and
the group or enrollment unit may agree that the profitable
or unprofitable experience may be calculated taking into
account the refund period and the immediately preceding 2
plan years.
The Health Maintenance Organization shall include a
statement in the evidence of coverage issued to each enrollee
describing the possibility of a refund or additional premium,
and upon request of any group or enrollment unit, provide to
the group or enrollment unit a description of the method used
to calculate (1) the Health Maintenance Organization's
profitable experience with respect to the group or enrollment
unit and the resulting refund to the group or enrollment unit
or (2) the Health Maintenance Organization's unprofitable
experience with respect to the group or enrollment unit and
the resulting additional premium to be paid by the group or

HB5493 Engrossed - 134 - LRB103 39189 RPS 69335 b
enrollment unit.
In no event shall the Illinois Health Maintenance
Organization Guaranty Association be liable to pay any
contractual obligation of an insolvent organization to pay any
refund authorized under this Section.
(g) Rulemaking authority to implement Public Act 95-1045,
if any, is conditioned on the rules being adopted in
accordance with all provisions of the Illinois Administrative
Procedure Act and all rules and procedures of the Joint
Committee on Administrative Rules; any purported rule not so
adopted, for whatever reason, is unauthorized.
(Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.)
(215 ILCS 125/5-3.1)
Sec. 5-3.1. Access to obstetrical and gynecological care
Woman's health care provider. Health maintenance organizations
are subject to the provisions of Section 356r of the Illinois

HB5493 Engrossed - 135 - LRB103 39189 RPS 69335 b
Insurance Code.
(Source: P.A. 89-514, eff. 7-17-96.)
Section 40. The Limited Health Service Organization Act is
amended by changing Sections 4002.1 and 4003 as follows:
(215 ILCS 130/4002.1)
Sec. 4002.1. Access to obstetrical and gynecological care
Woman's health care provider. Limited health service
organizations are subject to the provisions of Section 356r of
the Illinois Insurance Code.
(Source: P.A. 89-514, eff. 7-17-96.)
(215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
Sec. 4003. Illinois Insurance Code provisions. Limited
health service organizations shall be subject to the
provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 355.2,
355.3, 355b, 356q, 356v, 356z.4, 356z.4a, 356z.10, 356z.21,
356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32,
356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 364.3,
368a, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444,
and 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII
1/2, XXV, and XXVI of the Illinois Insurance Code. Nothing in

HB5493 Engrossed - 136 - LRB103 39189 RPS 69335 b
this Section shall require a limited health care plan to cover
any service that is not a limited health service. For purposes
of the Illinois Insurance Code, except for Sections 444 and
444.1 and Articles XIII and XIII 1/2, limited health service
organizations in the following categories are deemed to be
domestic companies:
(1) a corporation under the laws of this State; or
(2) a corporation organized under the laws of another
state, 30% or more of the enrollees of which are residents
of this State, except a corporation subject to
substantially the same requirements in its state of
organization as is a domestic company under Article VIII
1/2 of the Illinois Insurance Code.
(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
1-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,
eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
1-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
eff. 1-1-24; revised 8-29-23.)
Section 43. The Voluntary Health Services Plans Act is
amended by changing Section 10 as follows:
(215 ILCS 165/10) (from Ch. 32, par. 604)
Sec. 10. Application of Insurance Code provisions. Health

HB5493 Engrossed - 137 - LRB103 39189 RPS 69335 b
services plan corporations and all persons interested therein
or dealing therewith shall be subject to the provisions of
Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w,
356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5,
356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64,
356z.67, 356z.68, 364.01, 364.3, 367.2, 368a, 401, 401.1, 402,
403, 403A, 408, 408.2, and 412, and paragraphs (7) and (15) of
Section 367 of the Illinois Insurance Code.
Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,

HB5493 Engrossed - 138 - LRB103 39189 RPS 69335 b
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
103-551, eff. 8-11-23; revised 8-29-23.)
Section 45. The Illinois Public Aid Code is amended by
changing Section 5-16.9 as follows:
(305 ILCS 5/5-16.9)
Sec. 5-16.9. Access to obstetrical and gynecological care
Woman's health care provider. The medical assistance program
is subject to the provisions of Section 356r of the Illinois
Insurance Code. The Illinois Department shall adopt rules to
implement the requirements of Section 356r of the Illinois
Insurance Code in the medical assistance program including
managed care components.
On and after July 1, 2012, the Department shall reduce any
rate of reimbursement for services or other payments or alter
any methodologies authorized by this Code to reduce any rate
of reimbursement for services or other payments in accordance
with Section 5-5e.
(Source: P.A. 97-689, eff. 6-14-12.)
Section 95. No acceleration or delay. Where this Act makes
changes in a statute that is represented in this Act by text
that is not yet or no longer in effect (for example, a Section
represented by multiple versions), the use of that text does
not accelerate or delay the taking effect of (i) the changes

HB5493 Engrossed - 139 - LRB103 39189 RPS 69335 b
made by this Act or (ii) provisions derived from any other
Public Act.