Bill Text: IL SB2759 | 2023-2024 | 103rd General Assembly | Introduced


Bill Title: Creates the Adoptee Baseline Medical Testing Act. Requires medical intake forms for services provided by health care providers to include questions concerning the patient's adoption status and, if adopted, whether the patient has access to the patient's biological medical history. Provides that, if a patient has indicated on the medical intake form that the patient is adopted and does not have access to the patient's biological medical history, then, upon request by the patient or patient's parent or guardian, the health care provider shall provide no-cost, baseline testing with minimized time-bound restrictions for genetically predisposed conditions or diseases. Provides that if the patient or patient's parent or guardian requests such testing and the health care provider does not have personnel qualified to perform the testing, the health care provider must make a referral to another health care provider that is qualified to perform the testing and that will accept the referral. Subject to appropriation, requires the Department of Public Health, by rule, to create a State-funded system to pay for the baseline testing to the extent that another source does not cover the cost of the testing. Requires the Department of Public Health to develop educational materials and presentations for distribution to health care providers that provide information on the need for access to biological medical history and the detriments of lack of access to biological medical history for adoptees. Provides that the Department of Public Health shall administer and enforce the Act. Amends the Illinois Insurance Code to require coverage for baseline testing for genetically predisposed conditions or diseases if a patient has indicated on a medical intake form that the patient is adopted and does not have access to the patient's biological medical history. Provides that such a policy shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided. Makes conforming changes in the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Medical Assistance Article of the Illinois Public Aid Code.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2024-05-17 - Rule 3-9(a) / Re-referred to Assignments [SB2759 Detail]

Download: Illinois-2023-SB2759-Introduced.html

103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
SB2759

Introduced 1/16/2024, by Sen. Mattie Hunter

SYNOPSIS AS INTRODUCED:
See Index

Creates the Adoptee Baseline Medical Testing Act. Requires medical intake forms for services provided by health care providers to include questions concerning the patient's adoption status and, if adopted, whether the patient has access to the patient's biological medical history. Provides that, if a patient has indicated on the medical intake form that the patient is adopted and does not have access to the patient's biological medical history, then, upon request by the patient or patient's parent or guardian, the health care provider shall provide no-cost, baseline testing with minimized time-bound restrictions for genetically predisposed conditions or diseases. Provides that if the patient or patient's parent or guardian requests such testing and the health care provider does not have personnel qualified to perform the testing, the health care provider must make a referral to another health care provider that is qualified to perform the testing and that will accept the referral. Subject to appropriation, requires the Department of Public Health, by rule, to create a State-funded system to pay for the baseline testing to the extent that another source does not cover the cost of the testing. Requires the Department of Public Health to develop educational materials and presentations for distribution to health care providers that provide information on the need for access to biological medical history and the detriments of lack of access to biological medical history for adoptees. Provides that the Department of Public Health shall administer and enforce the Act. Amends the Illinois Insurance Code to require coverage for baseline testing for genetically predisposed conditions or diseases if a patient has indicated on a medical intake form that the patient is adopted and does not have access to the patient's biological medical history. Provides that such a policy shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided. Makes conforming changes in the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Medical Assistance Article of the Illinois Public Aid Code.
LRB103 36075 CES 66164 b

A BILL FOR

SB2759LRB103 36075 CES 66164 b
1 AN ACT concerning health.
2 Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4 Section 1. Short title. This Act may be cited as the
5Adoptee Baseline Medical Testing Act.
6 Section 5. Definitions. As used in this Act:
7 "Health care provider" means any public or private
8facility that provides, on an inpatient or outpatient basis,
9preventive, diagnostic, therapeutic, convalescent,
10rehabilitation, mental health, or intellectual disability
11services, including general or special hospitals, skilled
12nursing homes, extended care facilities, intermediate care
13facilities and mental health centers.
14 "Patient" means any person who has received or is
15receiving medical care, treatment or services from an
16individual or institution licensed to provide medical care or
17treatment in this State.
18 Section 10. Medical intake forms; baseline testing.
19Medical intake forms for services provided by health care
20providers must include questions concerning:
21 (1) the patient's adoption status; and
22 (2) if adopted, whether the patient has access to the

SB2759- 2 -LRB103 36075 CES 66164 b
1 patient's biological medical history.
2 If a patient has indicated on the medical intake form that
3the patient is adopted and does not have access to the
4patient's biological medical history, then, upon request by
5the patient or patient's parent or guardian, the health care
6provider, shall provide no-cost, baseline testing with
7minimized time-bound restrictions for genetically predisposed
8conditions or diseases, including, but not limited to,
9hypertension, diabetes, conditions or diseases related to
10reproductive health, and cancers. If the patient or patient's
11parent or guardian requests such testing and the health care
12provider does not have personnel qualified to perform the
13testing, the health care provider must make a referral to
14another health care provider that is qualified to perform the
15testing and that will accept the referral.
16 This Act shall not be construed to require baseline
17testing more than once.
18 Section 15. Payment. Subject to appropriation, the
19Department of Public Health shall, by rule, create a
20State-funded system to pay for baseline testing under Section
2110 to the extent that another source does not cover the cost of
22the testing. The patient must apply to any source that may be
23required to pay for testing, and may apply to the Department of
24Public Health only if all such applications are rejected. The
25patient must supply documentation of rejections, including

SB2759- 3 -LRB103 36075 CES 66164 b
1appeals, to the Department of Public Health in accordance with
2the Department's rules.
3 Section 20. Educational materials. The Department of
4Public Health shall develop educational materials and
5presentations for distribution to health care providers that
6provide information on the need for access to biological
7medical history and the detriments of lack of access to
8biological medical history for adoptees.
9 Section 25. Enforcement. The Department of Public Health
10shall administer and enforce this Act.
11 Section 900. The State Employees Group Insurance Act of
121971 is amended by changing Section 6.11 as follows:
13 (5 ILCS 375/6.11)
14 Sec. 6.11. Required health benefits; Illinois Insurance
15Code requirements. The program of health benefits shall
16provide the post-mastectomy care benefits required to be
17covered by a policy of accident and health insurance under
18Section 356t of the Illinois Insurance Code. The program of
19health benefits shall provide the coverage required under
20Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
21356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
22356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,

SB2759- 4 -LRB103 36075 CES 66164 b
1356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
2356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
3356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, 356z.60,
4and 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, 356z.70,
5and 356z.71 of the Illinois Insurance Code. The program of
6health benefits must comply with Sections 155.22a, 155.37,
7355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of the
8Illinois Insurance Code. The program of health benefits shall
9provide the coverage required under Section 356m of the
10Illinois Insurance Code and, for the employees of the State
11Employee Group Insurance Program only, the coverage as also
12provided in Section 6.11B of this Act. The Department of
13Insurance shall enforce the requirements of this Section with
14respect to Sections 370c and 370c.1 of the Illinois Insurance
15Code; all other requirements of this Section shall be enforced
16by the Department of Central Management Services.
17 Rulemaking authority to implement Public Act 95-1045, if
18any, is conditioned on the rules being adopted in accordance
19with all provisions of the Illinois Administrative Procedure
20Act and all rules and procedures of the Joint Committee on
21Administrative Rules; any purported rule not so adopted, for
22whatever reason, is unauthorized.
23(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
24102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
251-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768,
26eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;

SB2759- 5 -LRB103 36075 CES 66164 b
1102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
21-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84,
3eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24;
4103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff.
58-11-23; revised 8-29-23.)
6 Section 905. The Counties Code is amended by changing
7Section 5-1069.3 as follows:
8 (55 ILCS 5/5-1069.3)
9 Sec. 5-1069.3. Required health benefits. If a county,
10including a home rule county, is a self-insurer for purposes
11of providing health insurance coverage for its employees, the
12coverage shall include coverage for the post-mastectomy care
13benefits required to be covered by a policy of accident and
14health insurance under Section 356t and the coverage required
15under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356w, 356x,
16356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
17356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
18356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40,
19356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53,
20356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and
21356z.62, 356z.64, 356z.67, 356z.68, 356z.70, and 356z.71 of
22the Illinois Insurance Code. The coverage shall comply with
23Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
24Insurance Code. The Department of Insurance shall enforce the

SB2759- 6 -LRB103 36075 CES 66164 b
1requirements of this Section. The requirement that health
2benefits be covered as provided in this Section is an
3exclusive power and function of the State and is a denial and
4limitation under Article VII, Section 6, subsection (h) of the
5Illinois Constitution. A home rule county to which this
6Section applies must comply with every provision of this
7Section.
8 Rulemaking authority to implement Public Act 95-1045, if
9any, is conditioned on the rules being adopted in accordance
10with all provisions of the Illinois Administrative Procedure
11Act and all rules and procedures of the Joint Committee on
12Administrative Rules; any purported rule not so adopted, for
13whatever reason, is unauthorized.
14(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
15102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
161-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
17eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
18102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
191-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
20eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
21103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
228-29-23.)
23 Section 910. The Illinois Municipal Code is amended by
24changing Section 10-4-2.3 as follows:

SB2759- 7 -LRB103 36075 CES 66164 b
1 (65 ILCS 5/10-4-2.3)
2 Sec. 10-4-2.3. Required health benefits. If a
3municipality, including a home rule municipality, is a
4self-insurer for purposes of providing health insurance
5coverage for its employees, the coverage shall include
6coverage for the post-mastectomy care benefits required to be
7covered by a policy of accident and health insurance under
8Section 356t and the coverage required under Sections 356g,
9356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.4, 356z.4a,
10356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
11356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
12356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
13356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
14356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and 356z.62,
15356z.64, 356z.67, 356z.68, 356z.70, and 356z.71 of the
16Illinois Insurance Code. The coverage shall comply with
17Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
18Insurance Code. The Department of Insurance shall enforce the
19requirements of this Section. The requirement that health
20benefits be covered as provided in this is an exclusive power
21and function of the State and is a denial and limitation under
22Article VII, Section 6, subsection (h) of the Illinois
23Constitution. A home rule municipality to which this Section
24applies must comply with every provision of this Section.
25 Rulemaking authority to implement Public Act 95-1045, if
26any, is conditioned on the rules being adopted in accordance

SB2759- 8 -LRB103 36075 CES 66164 b
1with all provisions of the Illinois Administrative Procedure
2Act and all rules and procedures of the Joint Committee on
3Administrative Rules; any purported rule not so adopted, for
4whatever reason, is unauthorized.
5(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
6102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
71-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
8eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
9102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
101-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
11eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
12103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
138-29-23.)
14 Section 915. The School Code is amended by changing
15Section 10-22.3f as follows:
16 (105 ILCS 5/10-22.3f)
17 Sec. 10-22.3f. Required health benefits. Insurance
18protection and benefits for employees shall provide the
19post-mastectomy care benefits required to be covered by a
20policy of accident and health insurance under Section 356t and
21the coverage required under Sections 356g, 356g.5, 356g.5-1,
22356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8,
23356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
24356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,

SB2759- 9 -LRB103 36075 CES 66164 b
1356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
2356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and
3356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, 356z.70, and
4356z.71 of the Illinois Insurance Code. Insurance policies
5shall comply with Section 356z.19 of the Illinois Insurance
6Code. The coverage shall comply with Sections 155.22a, 355b,
7and 370c of the Illinois Insurance Code. The Department of
8Insurance shall enforce the requirements of this Section.
9 Rulemaking authority to implement Public Act 95-1045, if
10any, is conditioned on the rules being adopted in accordance
11with all provisions of the Illinois Administrative Procedure
12Act and all rules and procedures of the Joint Committee on
13Administrative Rules; any purported rule not so adopted, for
14whatever reason, is unauthorized.
15(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
16102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
171-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,
18eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
19102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.
201-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,
21eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;
22103-551, eff. 8-11-23; revised 8-29-23.)
23 Section 920. The Illinois Insurance Code is amended by
24adding Section 356z.71 as follows:

SB2759- 10 -LRB103 36075 CES 66164 b
1 (215 ILCS 5/356z.71 new)
2 Sec. 356z.71. Adoptee baseline medical testing. An
3individual or group policy of accident and health insurance
4amended, delivered, issued, or renewed in this State on or
5after January 1, 2025 shall provide coverage for baseline
6testing for genetically predisposed conditions or diseases,
7including, but not limited to, hypertension, diabetes,
8conditions or diseases related to reproductive health, and
9cancers, if a patient has indicated on a medical intake form
10that the patient is adopted and does not have access to the
11patient's biological medical history. A policy subject to this
12Section shall not impose a deductible, coinsurance, copayment,
13or any other cost-sharing requirement on the coverage
14provided.
15 Section 925. The Health Maintenance Organization Act is
16amended by changing Section 5-3 as follows:
17 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
18 Sec. 5-3. Insurance Code provisions.
19 (a) Health Maintenance Organizations shall be subject to
20the provisions of Sections 133, 134, 136, 137, 139, 140,
21141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
22154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49,
23355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356v,
24356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,

SB2759- 11 -LRB103 36075 CES 66164 b
1356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
2356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21, 356z.22,
3356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29, 356z.30,
4356z.30a, 356z.31, 356z.32, 356z.33, 356z.34, 356z.35,
5356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41, 356z.44,
6356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50, 356z.51,
7356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58, 356z.59,
8356z.60, 356z.61, 356z.62, 356z.64, 356z.65, 356z.67, 356z.68,
9356z.71, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b,
10368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A,
11408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
12subsection (2) of Section 367, and Articles IIA, VIII 1/2,
13XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
14Illinois Insurance Code.
15 (b) For purposes of the Illinois Insurance Code, except
16for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
17Health Maintenance Organizations in the following categories
18are deemed to be "domestic companies":
19 (1) a corporation authorized under the Dental Service
20 Plan Act or the Voluntary Health Services Plans Act;
21 (2) a corporation organized under the laws of this
22 State; or
23 (3) a corporation organized under the laws of another
24 state, 30% or more of the enrollees of which are residents
25 of this State, except a corporation subject to
26 substantially the same requirements in its state of

SB2759- 12 -LRB103 36075 CES 66164 b
1 organization as is a "domestic company" under Article VIII
2 1/2 of the Illinois Insurance Code.
3 (c) In considering the merger, consolidation, or other
4acquisition of control of a Health Maintenance Organization
5pursuant to Article VIII 1/2 of the Illinois Insurance Code,
6 (1) the Director shall give primary consideration to
7 the continuation of benefits to enrollees and the
8 financial conditions of the acquired Health Maintenance
9 Organization after the merger, consolidation, or other
10 acquisition of control takes effect;
11 (2)(i) the criteria specified in subsection (1)(b) of
12 Section 131.8 of the Illinois Insurance Code shall not
13 apply and (ii) the Director, in making his determination
14 with respect to the merger, consolidation, or other
15 acquisition of control, need not take into account the
16 effect on competition of the merger, consolidation, or
17 other acquisition of control;
18 (3) the Director shall have the power to require the
19 following information:
20 (A) certification by an independent actuary of the
21 adequacy of the reserves of the Health Maintenance
22 Organization sought to be acquired;
23 (B) pro forma financial statements reflecting the
24 combined balance sheets of the acquiring company and
25 the Health Maintenance Organization sought to be
26 acquired as of the end of the preceding year and as of

SB2759- 13 -LRB103 36075 CES 66164 b
1 a date 90 days prior to the acquisition, as well as pro
2 forma financial statements reflecting projected
3 combined operation for a period of 2 years;
4 (C) a pro forma business plan detailing an
5 acquiring party's plans with respect to the operation
6 of the Health Maintenance Organization sought to be
7 acquired for a period of not less than 3 years; and
8 (D) such other information as the Director shall
9 require.
10 (d) The provisions of Article VIII 1/2 of the Illinois
11Insurance Code and this Section 5-3 shall apply to the sale by
12any health maintenance organization of greater than 10% of its
13enrollee population (including, without limitation, the health
14maintenance organization's right, title, and interest in and
15to its health care certificates).
16 (e) In considering any management contract or service
17agreement subject to Section 141.1 of the Illinois Insurance
18Code, the Director (i) shall, in addition to the criteria
19specified in Section 141.2 of the Illinois Insurance Code,
20take into account the effect of the management contract or
21service agreement on the continuation of benefits to enrollees
22and the financial condition of the health maintenance
23organization to be managed or serviced, and (ii) need not take
24into account the effect of the management contract or service
25agreement on competition.
26 (f) Except for small employer groups as defined in the

SB2759- 14 -LRB103 36075 CES 66164 b
1Small Employer Rating, Renewability and Portability Health
2Insurance Act and except for medicare supplement policies as
3defined in Section 363 of the Illinois Insurance Code, a
4Health Maintenance Organization may by contract agree with a
5group or other enrollment unit to effect refunds or charge
6additional premiums under the following terms and conditions:
7 (i) the amount of, and other terms and conditions with
8 respect to, the refund or additional premium are set forth
9 in the group or enrollment unit contract agreed in advance
10 of the period for which a refund is to be paid or
11 additional premium is to be charged (which period shall
12 not be less than one year); and
13 (ii) the amount of the refund or additional premium
14 shall not exceed 20% of the Health Maintenance
15 Organization's profitable or unprofitable experience with
16 respect to the group or other enrollment unit for the
17 period (and, for purposes of a refund or additional
18 premium, the profitable or unprofitable experience shall
19 be calculated taking into account a pro rata share of the
20 Health Maintenance Organization's administrative and
21 marketing expenses, but shall not include any refund to be
22 made or additional premium to be paid pursuant to this
23 subsection (f)). The Health Maintenance Organization and
24 the group or enrollment unit may agree that the profitable
25 or unprofitable experience may be calculated taking into
26 account the refund period and the immediately preceding 2

SB2759- 15 -LRB103 36075 CES 66164 b
1 plan years.
2 The Health Maintenance Organization shall include a
3statement in the evidence of coverage issued to each enrollee
4describing the possibility of a refund or additional premium,
5and upon request of any group or enrollment unit, provide to
6the group or enrollment unit a description of the method used
7to calculate (1) the Health Maintenance Organization's
8profitable experience with respect to the group or enrollment
9unit and the resulting refund to the group or enrollment unit
10or (2) the Health Maintenance Organization's unprofitable
11experience with respect to the group or enrollment unit and
12the resulting additional premium to be paid by the group or
13enrollment unit.
14 In no event shall the Illinois Health Maintenance
15Organization Guaranty Association be liable to pay any
16contractual obligation of an insolvent organization to pay any
17refund authorized under this Section.
18 (g) Rulemaking authority to implement Public Act 95-1045,
19if any, is conditioned on the rules being adopted in
20accordance with all provisions of the Illinois Administrative
21Procedure Act and all rules and procedures of the Joint
22Committee on Administrative Rules; any purported rule not so
23adopted, for whatever reason, is unauthorized.
24(Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
25102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
261-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,

SB2759- 16 -LRB103 36075 CES 66164 b
1eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
2102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
31-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
4eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
5103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
66-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
7eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.)
8 Section 930. The Limited Health Service Organization Act
9is amended by changing Section 4003 as follows:
10 (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
11 Sec. 4003. Illinois Insurance Code provisions. Limited
12health service organizations shall be subject to the
13provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
14141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
15154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 355.2,
16355.3, 355b, 356q, 356v, 356z.4, 356z.4a, 356z.10, 356z.21,
17356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32,
18356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
19356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 356z.71,
20364.3, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412,
21444, and 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,
22XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
23Nothing in this Section shall require a limited health care
24plan to cover any service that is not a limited health service.

SB2759- 17 -LRB103 36075 CES 66164 b
1For purposes of the Illinois Insurance Code, except for
2Sections 444 and 444.1 and Articles XIII and XIII 1/2, limited
3health service organizations in the following categories are
4deemed to be domestic companies:
5 (1) a corporation under the laws of this State; or
6 (2) a corporation organized under the laws of another
7 state, 30% or more of the enrollees of which are residents
8 of this State, except a corporation subject to
9 substantially the same requirements in its state of
10 organization as is a domestic company under Article VIII
11 1/2 of the Illinois Insurance Code.
12(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
13102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
141-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,
15eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
16102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
171-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
18eff. 1-1-24; revised 8-29-23.)
19 Section 935. The Voluntary Health Services Plans Act is
20amended by changing Section 10 as follows:
21 (215 ILCS 165/10) (from Ch. 32, par. 604)
22 Sec. 10. Application of Insurance Code provisions. Health
23services plan corporations and all persons interested therein
24or dealing therewith shall be subject to the provisions of

SB2759- 18 -LRB103 36075 CES 66164 b
1Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
2143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
3356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w,
4356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5,
5356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
6356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
7356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
8356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
9356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64,
10356z.67, 356z.68, 356z.71, 364.01, 364.3, 367.2, 368a, 401,
11401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)
12and (15) of Section 367 of the Illinois Insurance Code.
13 Rulemaking authority to implement Public Act 95-1045, if
14any, is conditioned on the rules being adopted in accordance
15with all provisions of the Illinois Administrative Procedure
16Act and all rules and procedures of the Joint Committee on
17Administrative Rules; any purported rule not so adopted, for
18whatever reason, is unauthorized.
19(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
20102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
2110-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
22eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
23102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
241-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
25eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
26103-551, eff. 8-11-23; revised 8-29-23.)

SB2759- 19 -LRB103 36075 CES 66164 b
1 Section 940. The Illinois Public Aid Code is amended by
2changing Section 5-16.8 as follows:
3 (305 ILCS 5/5-16.8)
4 Sec. 5-16.8. Required health benefits. The medical
5assistance program shall (i) provide the post-mastectomy care
6benefits required to be covered by a policy of accident and
7health insurance under Section 356t and the coverage required
8under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
9356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
10356z.47, 356z.51, 356z.53, 356z.56, 356z.59, 356z.60, and
11356z.61, 356z.64, 356z.67, and 356z.71 of the Illinois
12Insurance Code, (ii) be subject to the provisions of Sections
13356z.19, 356z.44, 356z.49, 364.01, 370c, and 370c.1 of the
14Illinois Insurance Code, and (iii) be subject to the
15provisions of subsection (d-5) of Section 10 of the Network
16Adequacy and Transparency Act.
17 The Department, by rule, shall adopt a model similar to
18the requirements of Section 356z.39 of the Illinois Insurance
19Code.
20 On and after July 1, 2012, the Department shall reduce any
21rate of reimbursement for services or other payments or alter
22any methodologies authorized by this Code to reduce any rate
23of reimbursement for services or other payments in accordance
24with Section 5-5e.

SB2759- 20 -LRB103 36075 CES 66164 b
1 To ensure full access to the benefits set forth in this
2Section, on and after January 1, 2016, the Department shall
3ensure that provider and hospital reimbursement for
4post-mastectomy care benefits required under this Section are
5no lower than the Medicare reimbursement rate.
6(Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22;
7102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff.
81-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813,
9eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23;
10102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
111-1-24; 103-420, eff. 1-1-24; revised 12-15-23.)

SB2759- 21 -LRB103 36075 CES 66164 b
1 INDEX
2 Statutes amended in order of appearance