Bill Text: IL HB4703 | 2021-2022 | 102nd General Assembly | Chaptered

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Bill Title: Amends the Illinois Insurance Code. Provides that when an insured receives emergency services or covered ancillary services from a nonparticipating provider or a nonparticipating facility, the health insurance issuer shall ensure that cost-sharing requirements are applied as though the services had been received from a participating provider or facility, and that the insured or any group policyholder or plan sponsor shall not be liable to or billed by the health insurance issuer, the nonparticipating provider, or the facility beyond the cost-sharing amount. Contains provisions concerning a notice and consent process for out-of-network coverage; billing for reasonable administrative fees; assignment of benefits to nonparticipating providers; and cost-sharing amounts and deductibles. Amends the Illinois Insurance Code and the Health Maintenance Organization Act to make a change in provisions concerning disclosure of nonparticipating provider benefits. Amends the Network Adequacy and Transparency Act. Provides that a beneficiary who receives care at a participating health care facility shall not be required to search for participating providers under certain circumstances. Amends the Managed Care Reform and Patient Rights Act. Provides that prior authorization or approval by the plan shall not be required for post-stabilization services that constitute emergency services. Amends the Health Maintenance Organization Act and the Voluntary Health Services Plans Act to provide that health maintenance organizations and voluntary health services plans are subject to provisions of the Illinois Insurance Code concerning billing and cost sharing. Makes other changes. Effective July 1, 2022, except that certain changes take effect January 1, 2023.

Spectrum: Partisan Bill (Democrat 26-0)

Status: (Passed) 2022-07-01 - Added as Alternate Co-Sponsor Sen. Doris Turner [HB4703 Detail]

Download: Illinois-2021-HB4703-Chaptered.html

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Public Act 102-0901
HB4703 Enrolled LRB102 24386 BMS 33620 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Insurance Code is amended by
changing Sections 356z.3 and 356z.3a as follows:
(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 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
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. 96-1523, eff. 6-1-11; 97-813, eff. 7-13-12.)
(215 ILCS 5/356z.3a)
Sec. 356z.3a. Billing; emergency services;
nonparticipating providers Nonparticipating facility-based

physicians and providers.
(a) As used in this Section: For purposes of this Section,
"facility-based provider" means a physician or other provider
who provide radiology, anesthesiology, pathology, neonatology,
or emergency department services to insureds, beneficiaries,
or enrollees in a participating hospital or participating
ambulatory surgical treatment center.
"Ancillary services" means:
(1) items and services related to emergency medicine,
anesthesiology, pathology, radiology, and neonatology that
are provided by any health care provider;
(2) items and services provided by assistant surgeons,
hospitalists, and intensivists;
(3) diagnostic services, including radiology and
laboratory services, except for advanced diagnostic
laboratory tests identified on the most current list
published by the United States Secretary of Health and
Human Services under 42 U.S.C. 300gg-132(b)(3);
(4) items and services provided by other specialty
practitioners as the United States Secretary of Health and
Human Services specifies through rulemaking under 42
U.S.C. 300gg-132(b)(3); and
(5) items and services provided by a nonparticipating
provider if there is no participating provider who can
furnish the item or service at the facility.
"Cost sharing" means the amount an insured, beneficiary,

or enrollee is responsible for paying for a covered item or
service under the terms of the policy or certificate. "Cost
sharing" includes copayments, coinsurance, and amounts paid
toward deductibles, but does not include amounts paid towards
premiums, balance billing by out-of-network providers, or the
cost of items or services that are not covered under the policy
or certificate.
"Emergency department of a hospital" means any hospital
department that provides emergency services, including a
hospital outpatient department.
"Emergency medical condition" has the meaning ascribed to
that term in Section 10 of the Managed Care Reform and Patient
Rights Act.
"Emergency medical screening examination" has the meaning
ascribed to that term in Section 10 of the Managed Care Reform
and Patient Rights Act.
"Emergency services" means, with respect to an emergency
medical condition:
(1) in general, an emergency medical screening
examination, including ancillary services routinely
available to the emergency department to evaluate such
emergency medical condition, and such further medical
examination and treatment as would be required to
stabilize the patient regardless of the department of the
hospital or other facility in which such further
examination or treatment is furnished; or

(2) additional items and services for which benefits
are provided or covered under the coverage and that are
furnished by a nonparticipating provider or
nonparticipating emergency facility regardless of the
department of the hospital or other facility in which such
items are furnished after the insured, beneficiary, or
enrollee is stabilized and as part of outpatient
observation or an inpatient or outpatient stay with
respect to the visit in which the services described in
paragraph (1) are furnished. Services after stabilization
cease to be emergency services only when all the
conditions of 42 U.S.C. 300gg-111(a)(3)(C)(ii)(II) and
regulations thereunder are met.
"Freestanding Emergency Center" means a facility licensed
under Section 32.5 of the Emergency Medical Services (EMS)
Systems Act.
"Health care facility" means, in the context of
non-emergency services, any of the following:
(1) a hospital as defined in 42 U.S.C. 1395x(e);
(2) a hospital outpatient department;
(3) a critical access hospital certified under 42
U.S.C. 1395i-4(e);
(4) an ambulatory surgical treatment center as defined
in the Ambulatory Surgical Treatment Center Act; or
(5) any recipient of a license under the Hospital
Licensing Act that is not otherwise described in this

definition.
"Health care provider" means a provider as defined in
subsection (d) of Section 370g. "Health care provider" does
not include a provider of air ambulance or ground ambulance
services.
"Health care services" has the meaning ascribed to that
term in subsection (a) of Section 370g.
"Health insurance issuer" has the meaning ascribed to that
term in Section 5 of the Illinois Health Insurance Portability
and Accountability Act.
"Nonparticipating emergency facility" means, with respect
to the furnishing of an item or service under a policy of group
or individual health insurance coverage, any of the following
facilities that does not have a contractual relationship
directly or indirectly with a health insurance issuer in
relation to the coverage:
(1) an emergency department of a hospital;
(2) a Freestanding Emergency Center;
(3) an ambulatory surgical treatment center as defined
in the Ambulatory Surgical Treatment Center Act; or
(4) with respect to emergency services described in
paragraph (2) of the definition of "emergency services", a
hospital.
"Nonparticipating provider" means, with respect to the
furnishing of an item or service under a policy of group or
individual health insurance coverage, any health care provider

who does not have a contractual relationship directly or
indirectly with a health insurance issuer in relation to the
coverage.
"Participating emergency facility" means any of the
following facilities that has a contractual relationship
directly or indirectly with a health insurance issuer offering
group or individual health insurance coverage setting forth
the terms and conditions on which a relevant health care
service is provided to an insured, beneficiary, or enrollee
under the coverage:
(1) an emergency department of a hospital;
(2) a Freestanding Emergency Center;
(3) an ambulatory surgical treatment center as defined
in the Ambulatory Surgical Treatment Center Act; or
(4) with respect to emergency services described in
paragraph (2) of the definition of "emergency services", a
hospital.
For purposes of this definition, a single case agreement
between an emergency facility and an issuer that is used to
address unique situations in which an insured, beneficiary, or
enrollee requires services that typically occur out-of-network
constitutes a contractual relationship and is limited to the
parties to the agreement.
"Participating health care facility" means any health care
facility that has a contractual relationship directly or
indirectly with a health insurance issuer offering group or

individual health insurance coverage setting forth the terms
and conditions on which a relevant health care service is
provided to an insured, beneficiary, or enrollee under the
coverage. A single case agreement between an emergency
facility and an issuer that is used to address unique
situations in which an insured, beneficiary, or enrollee
requires services that typically occur out-of-network
constitutes a contractual relationship for purposes of this
definition and is limited to the parties to the agreement.
"Participating provider" means any health care provider
that has a contractual relationship directly or indirectly
with a health insurance issuer offering group or individual
health insurance coverage setting forth the terms and
conditions on which a relevant health care service is provided
to an insured, beneficiary, or enrollee under the coverage.
"Qualifying payment amount" has the meaning given to that
term in 42 U.S.C. 300gg-111(a)(3)(E) and the regulations
promulgated thereunder.
"Recognized amount" means the lesser of the amount
initially billed by the provider or the qualifying payment
amount.
"Stabilize" means "stabilization" as defined in Section 10
of the Managed Care Reform and Patient Rights Act.
"Treating provider" means a health care provider who has
evaluated the individual.
"Visit" means, with respect to health care services

furnished to an individual at a health care facility, health
care services furnished by a provider at the facility, as well
as equipment, devices, telehealth services, imaging services,
laboratory services, and preoperative and postoperative
services regardless of whether the provider furnishing such
services is at the facility.
(b) Emergency services. When a beneficiary, insured, or
enrollee receives emergency services from a nonparticipating
provider or a nonparticipating emergency facility, the health
insurance issuer shall ensure that the beneficiary, insured,
or enrollee shall incur no greater out-of-pocket costs than
the beneficiary, insured, or enrollee would have incurred with
a participating provider or a participating emergency
facility. Any cost-sharing requirements shall be applied as
though the emergency services had been received from a
participating provider or a participating facility. Cost
sharing shall be calculated based on the recognized amount for
the emergency services. If the cost sharing for the same item
or service furnished by a participating provider would have
been a flat-dollar copayment, that amount shall be the
cost-sharing amount unless the provider has billed a lesser
total amount. In no event shall the beneficiary, insured,
enrollee, or any group policyholder or plan sponsor be liable
to or billed by the health insurance issuer, the
nonparticipating provider, or the nonparticipating emergency
facility for any amount beyond the cost sharing calculated in

accordance with this subsection with respect to the emergency
services delivered. Administrative requirements or limitations
shall be no greater than those applicable to emergency
services received from a participating provider or a
participating emergency facility.
(b-5) Non-emergency services at participating health care
facilities.
(1) When a beneficiary, insured, or enrollee utilizes
a participating health care facility network hospital or a
participating network ambulatory surgery center and, due
to any reason, covered ancillary services in network
services for radiology, anesthesiology, pathology,
emergency physician, or neonatology are unavailable and
are provided by a nonparticipating facility-based
physician or provider during or resulting from the visit,
the health insurance issuer insurer or health plan shall
ensure that the beneficiary, insured, or enrollee shall
incur no greater out-of-pocket costs than the beneficiary,
insured, or enrollee would have incurred with a
participating physician or provider for the ancillary
covered services. Any cost-sharing requirements shall be
applied as though the ancillary services had been received
from a participating provider. Cost sharing shall be
calculated based on the recognized amount for the
ancillary services. If the cost sharing for the same item
or service furnished by a participating provider would

have been a flat-dollar copayment, that amount shall be
the cost-sharing amount unless the provider has billed a
lesser total amount. In no event shall the beneficiary,
insured, enrollee, or any group policyholder or plan
sponsor be liable to or billed by the health insurance
issuer, the nonparticipating provider, or the
participating health care facility for any amount beyond
the cost sharing calculated in accordance with this
subsection with respect to the ancillary services
delivered. In addition to ancillary services, the
requirements of this paragraph shall also apply with
respect to covered items or services furnished as a result
of unforeseen, urgent medical needs that arise at the time
an item or service is furnished, regardless of whether the
nonparticipating provider satisfied the notice and consent
criteria under paragraph (2) of this subsection.
(2) When a beneficiary, insured, or enrollee utilizes
a participating health care facility and receives
non-emergency covered health care services other than
those described in paragraph (1) of this subsection from a
nonparticipating provider during or resulting from the
visit, the health insurance issuer shall ensure that the
beneficiary, insured, or enrollee incurs no greater
out-of-pocket costs than the beneficiary, insured, or
enrollee would have incurred with a participating provider
unless the nonparticipating provider, or the participating

health care facility on behalf of the nonparticipating
provider, satisfies the notice and consent criteria
provided in 42 U.S.C. 300gg-132 and regulations
promulgated thereunder. If the notice and consent criteria
are not satisfied, then:
(A) any cost-sharing requirements shall be applied
as though the health care services had been received
from a participating provider;
(B) cost sharing shall be calculated based on the
recognized amount for the health care services; and
(C) in no event shall the beneficiary, insured,
enrollee, or any group policyholder or plan sponsor be
liable to or billed by the health insurance issuer,
the nonparticipating provider, or the participating
health care facility for any amount beyond the cost
sharing calculated in accordance with this subsection
with respect to the health care services delivered.
(c) Notwithstanding If a beneficiary, insured, or enrollee
agrees in writing, notwithstanding any other provision of this
Code, except when the notice and consent criteria are
satisfied for the situation in paragraph (2) of subsection
(b-5), any benefits a beneficiary, insured, or enrollee
receives for services under the situations situation in
subsections subsection (b) or (b-5) are assigned to the
nonparticipating facility-based providers or the facility
acting on their behalf. Upon receipt of the provider's bill or

facility's bill, the health insurance issuer The insurer or
health plan shall provide the nonparticipating provider or the
facility with a written explanation of benefits that specifies
the proposed reimbursement and the applicable deductible,
copayment or coinsurance amounts owed by the insured,
beneficiary or enrollee. The health insurance issuer insurer
or health plan shall pay any reimbursement subject to this
Section directly to the nonparticipating facility-based
provider or the facility. The nonparticipating facility-based
physician or provider shall not bill the beneficiary, insured,
or enrollee, except for applicable deductible, copayment, or
coinsurance amounts that would apply if the beneficiary,
insured, or enrollee utilized a participating physician or
provider for covered services. If a beneficiary, insured, or
enrollee specifically rejects assignment under this Section in
writing to the nonparticipating facility-based provider, then
the nonparticipating facility-based provider may bill the
beneficiary, insured, or enrollee for the services rendered.
(d) For bills assigned under subsection (c), the
nonparticipating facility-based provider or the facility may
bill the health insurance issuer insurer or health plan for
the services rendered, and the health insurance issuer insurer
or health plan may pay the billed amount or attempt to
negotiate reimbursement with the nonparticipating
facility-based provider or the facility. Within 30 calendar
days after the provider or facility transmits the bill to the

health insurance issuer, the issuer shall send an initial
payment or notice of denial of payment with the written
explanation of benefits to the provider or facility. If
attempts to negotiate reimbursement for services provided by a
nonparticipating facility-based provider do not result in a
resolution of the payment dispute within 30 days after receipt
of written explanation of benefits by the health insurance
issuer insurer or health plan, then the health insurance
issuer an insurer or health plan or nonparticipating
facility-based physician or provider or the facility may
initiate binding arbitration to determine payment for services
provided on a per bill basis. The party requesting arbitration
shall notify the other party arbitration has been initiated
and state its final offer before arbitration. In response to
this notice, the nonrequesting party shall inform the
requesting party of its final offer before the arbitration
occurs. Arbitration shall be initiated by filing a request
with the Department of Insurance.
(e) The Department of Insurance shall publish a list of
approved arbitrators or entities that shall provide binding
arbitration. These arbitrators shall be American Arbitration
Association or American Health Lawyers Association trained
arbitrators. Both parties must agree on an arbitrator from the
Department of Insurance's or its approved entity's list of
arbitrators. If no agreement can be reached, then a list of 5
arbitrators shall be provided by the Department of Insurance

or the approved entity. From the list of 5 arbitrators, the
health insurance issuer insurer can veto 2 arbitrators and the
provider or facility can veto 2 arbitrators. The remaining
arbitrator shall be the chosen arbitrator. This arbitration
shall consist of a review of the written submissions by both
parties. The arbitrator shall not establish a rebuttable
presumption that the qualifying payment amount should be the
total amount owed to the provider or facility by the
combination of the issuer and the insured, beneficiary, or
enrollee. Binding arbitration shall provide for a written
decision within 45 days after the request is filed with the
Department of Insurance. Both parties shall be bound by the
arbitrator's decision. The arbitrator's expenses and fees,
together with other expenses, not including attorney's fees,
incurred in the conduct of the arbitration, shall be paid as
provided in the decision.
(f) (Blank). This Section 356z.3a does not apply to a
beneficiary, insured, or enrollee who willfully chooses to
access a nonparticipating facility-based physician or provider
for health care services available through the insurer's or
plan's network of participating physicians and providers. In
these circumstances, the contractual requirements for
nonparticipating facility-based provider reimbursements will
apply.
(g) Section 368a of this Act shall not apply during the
pendency of a decision under subsection (d). Upon the issuance

of the arbitrator's decision, Section 368a applies with
respect to the amount, if any, by which the arbitrator's
determination exceeds the issuer's initial payment under
subsection (c), or the entire amount of the arbitrator's
determination if initial payment was denied. Any any interest
required to be paid a provider under Section 368a shall not
accrue until after 30 days of an arbitrator's decision as
provided in subsection (d), but in no circumstances longer
than 150 days from date the nonparticipating facility-based
provider billed for services rendered.
(h) Nothing in this Section shall be interpreted to change
the prudent layperson provisions with respect to emergency
services under the Managed Care Reform and Patient Rights Act.
(i) Nothing in this Section shall preclude a health care
provider from billing a beneficiary, insured, or enrollee for
reasonable administrative fees, such as service fees for
checks returned for nonsufficient funds and missed
appointments.
(j) Nothing in this Section shall preclude a beneficiary,
insured, or enrollee from assigning benefits to a
nonparticipating provider when the notice and consent criteria
are satisfied under paragraph (2) of subsection (b-5) or in
any other situation not described in subsections (b) or (b-5).
(k) Except when the notice and consent criteria are
satisfied under paragraph (2) of subsection (b-5), if an
individual receives health care services under the situations

described in subsections (b) or (b-5), no referral requirement
or any other provision contained in the policy or certificate
of coverage shall deny coverage, reduce benefits, or otherwise
defeat the requirements of this Section for services that
would have been covered with a participating provider.
However, this subsection shall not be construed to preclude a
provider contract with a health insurance issuer, or with an
administrator or similar entity acting on the issuer's behalf,
from imposing requirements on the participating provider,
participating emergency facility, or participating health care
facility relating to the referral of covered individuals to
nonparticipating providers.
(l) Except if the notice and consent criteria are
satisfied under paragraph (2) of subsection (b-5),
cost-sharing amounts calculated in conformity with this
Section shall count toward any deductible or out-of-pocket
maximum applicable to in-network coverage.
(m) The Department has the authority to enforce the
requirements of this Section in the situations described in
subsections (b) and (b-5), and in any other situation for
which 42 U.S.C. Chapter 6A, Subchapter XXV, Parts D or E and
regulations promulgated thereunder would prohibit an
individual from being billed or liable for emergency services
furnished by a nonparticipating provider or nonparticipating
emergency facility or for non-emergency health care services
furnished by a nonparticipating provider at a participating

health care facility.
(n) This Section does not apply with respect to air
ambulance or ground ambulance services. This Section does not
apply to any policy of excepted benefits or to short-term,
limited-duration health insurance coverage.
(Source: P.A. 98-154, eff. 8-2-13.)
Section 10. The Network Adequacy and Transparency Act is
amended by changing Section 10 as follows:
(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.
(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 woman'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
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
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, or unreasonable travel distance
or delay, 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 subsections (b) or (b-5) of Section 356z.3a of the
Illinois Insurance Code except under the circumstances
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 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
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;
(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
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,
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
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
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)
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.)
Section 15. The Health Maintenance Organization Act is
amended by changing Sections 4.5-1 and 5-3 as follows:
(215 ILCS 125/4.5-1)
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 the effective date of this amendatory Act of
the 92nd General Assembly, must include the following
disclosure on its point-of-service contracts and evidences
of coverage: "WARNING, LIMITED BENEFITS WILL BE PAID WHEN
NON-PARTICIPATING 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, 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 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
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
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 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
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. 92-135, eff. 1-1-02; 92-579, eff. 1-1-03.)
(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, 355.2,
355.3, 355b, 356g.5-1, 356m, 356q, 356v, 356w, 356x, 356y,
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.21, 356z.22, 356z.25, 356z.26,
356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, 356z.35,
356z.36, 356z.40, 356z.41, 356z.43, 356z.46, 356z.47, 356z.48,
356z.50, 356z.51, 364, 364.01, 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 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
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
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
(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
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. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-393, eff.
1-1-20; 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625,
eff. 1-1-21; 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; revised 10-27-21.)
Section 20. The Managed Care Reform and Patient Rights Act
is amended by changing Section 70 as follows:
(215 ILCS 134/70)
Sec. 70. Post-stabilization medical services.
(a) If prior authorization for covered post-stabilization
services is required by the health care plan, the plan shall
provide access 24 hours a day, 7 days a week to persons
designated by the plan to make such determinations, provided
that any determination made under this Section must be made by
a health care professional. The review shall be resolved in
accordance with the provisions of Section 85 and the time
requirements of this Section.

(a-5) Prior authorization or approval by the plan shall
not be required for post-stabilization services that
constitute emergency services under Section 356z.3a of the
Illinois Insurance Code.
(b) The treating physician licensed to practice medicine
in all its branches or health care provider shall contact the
health care plan or delegated health care provider as
designated on the enrollee's health insurance card to obtain
authorization, denial, or arrangements for an alternate plan
of treatment or transfer of the enrollee.
(c) The treating physician licensed to practice medicine
in all its branches or health care provider shall document in
the enrollee's medical record the enrollee's presenting
symptoms; emergency medical condition; and time, phone number
dialed, and result of the communication for request for
authorization of post-stabilization medical services. The
health care plan shall provide reimbursement for covered
post-stabilization medical services if:
(1) authorization to render them is received from the
health care plan or its delegated health care provider, or
(2) after 2 documented good faith efforts, the
treating health care provider has attempted to contact the
enrollee's health care plan or its delegated health care
provider, as designated on the enrollee's health insurance
card, for prior authorization of post-stabilization
medical services and neither the plan nor designated

persons were accessible or the authorization was not
denied within 60 minutes of the request. "Two documented
good faith efforts" means the health care provider has
called the telephone number on the enrollee's health
insurance card or other available number either 2 times or
one time and an additional call to any referral number
provided. "Good faith" means honesty of purpose, freedom
from intention to defraud, and being faithful to one's
duty or obligation. For the purpose of this Act, good
faith shall be presumed.
(d) After rendering any post-stabilization medical
services, the treating physician licensed to practice medicine
in all its branches or health care provider shall continue to
make every reasonable effort to contact the health care plan
or its delegated health care provider regarding authorization,
denial, or arrangements for an alternate plan of treatment or
transfer of the enrollee until the treating health care
provider receives instructions from the health care plan or
delegated health care provider for continued care or the care
is transferred to another health care provider or the patient
is discharged.
(e) Payment for covered post-stabilization services may be
denied:
(1) if the treating health care provider does not meet
the conditions outlined in subsection (c);
(2) upon determination that the post-stabilization

services claimed were not performed;
(3) upon timely determination that the
post-stabilization services rendered were contrary to the
instructions of the health care plan or its delegated
health care provider if contact was made between those
parties prior to the service being rendered;
(4) upon determination that the patient receiving such
services was not an enrollee of the health care plan; or
(5) upon material misrepresentation by the enrollee or
health care provider; "material" means a fact or situation
that is not merely technical in nature and results or
could result in a substantial change in the situation.
(f) Nothing in this Section prohibits a health care plan
from delegating tasks associated with the responsibilities
enumerated in this Section to the health care plan's
contracted health care providers or another entity. Only a
clinical peer may make an adverse determination. However, the
ultimate responsibility for coverage and payment decisions may
not be delegated.
(g) Coverage and payment for post-stabilization medical
services for which prior authorization or deemed approval is
received shall not be retrospectively denied.
(h) Nothing in this Section shall prohibit the imposition
of deductibles, copayments, and co-insurance. Nothing in this
Section alters the prohibition on billing enrollees contained
in the Health Maintenance Organization Act.

(Source: P.A. 91-617, eff. 1-1-00.)
Section 25. 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
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.43, 364.01,
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. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff.
1-1-21; 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;
revised 10-27-21.)
Section 99. Effective date. This Act takes effect July 1,
2022, except that the changes to Section 356z.3 of the
Illinois Insurance Code and Section 4.5-1 of the Health
Maintenance Organization Act take effect January 1, 2023.