Bill Text: IL SB2838 | 2025-2026 | 104th General Assembly | Enrolled

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Bill Title: Amends the Illinois Insurance Code. Prohibits a hearing care organization that is an issuer or administrator of a hearing care plan or discounted hearing care plan issued, delivered, amended, or renewed on or after the effective date of the amendatory Act from issuing or renewing a contract that requires a hearing instrument professional, as a condition of participation in the hearing care plan or discounted hearing care plan, to provide items or services to an enrollee at a fee set by the hearing care plan or discounted hearing care plan unless the items and services are covered items or covered services under the hearing care plan or discounted hearing care plan. Provides that a hearing instrument professional who chooses not to accept as payment an amount set by a hearing care plan or discounted hearing care plan for items and services that are not covered by the hearing care plan or discounted hearing care plan shall comply with the specified notification requirements. Requires hearing care benefits to be communicated in writing by the hearing care organization to an enrollee, prospective enrollee, and the hearing instrument professional. Provides that no hearing care organization or its officers, directors, agents, and employees may represent a discount hearing care benefit as a funded hearing care benefit. Allows a hearing care plan or discounted hearing care plan to provide hearing care benefits that include routine hearing care services and medically necessary diagnostic hearing services in accordance with guidance promulgated by the Centers for Medicare and Medicaid Services. Makes other changes. Amends the Health Maintenance Organization Act and the Limited Health Service Organization Act to conform with the requirements for hearing care plans and discounted hearing care plans. Effective January 1, 2027.

Sponsorship: Partisan Bill (Democrat 6)

Status: (Enrolled) 2026-06-18 - Sent to the Governor [SB2838 Detail]

Download: Illinois-2025-SB2838-Enrolled.html

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SB2838 Enrolled LRB104 17737 BAB 31168 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
adding Sections 356z.88, 370u, and 511.119 as follows:
(215 ILCS 5/356z.88 new)
Sec. 356z.88. Hearing care plans and discounted hearing
care plans.
(a) Definitions. In this Section:
"Administrator" means any administrator as defined in
Section 370g or 511.101 of this Code.
"Cost sharing" has the meaning given to that term in
Section 356z.3a of this Code.
"Covered items" means items for which reimbursement or
capitation from an enrollee's hearing care plan is provided to
a hearing instrument professional or for which a reimbursement
or discount is provided to an enrollee under a hearing care
plan or discounted hearing care plan.
"Covered items" includes, but is not limited to,
prescription hearing aids, earmolds, domes or inserts,
assistive listening devices, and hearing aid supplies and
accessories. "Covered items" does not include over-the-counter
hearing aids as defined in 21 CFR 800.30(b).

SB2838 Enrolled - 2 - LRB104 17737 BAB 31168 b
"Covered services" means services for which reimbursement
or capitation from an enrollee's hearing care plan is provided
to a hearing instrument professional or for which a
reimbursement or discount is provided to an enrollee under a
hearing care plan or discounted hearing care plan.
"Discount hearing care benefit" means a hearing care
benefit that is offered in a discounted hearing care plan.
"Discounted hearing care plan" means a discounted health
care services plan, as defined in 50 Ill. Adm. Code 2051.220,
that provides discounts for covered items or services.
"Enrollee" means any individual enrolled in a hearing care
plan or a beneficiary of a discounted hearing care plan.
"Excepted benefits" has the meaning given to that term in
42 U.S.C. 300gg-91(c) and federal regulations thereunder.
"Funded hearing care benefit" means hearing care benefits
that are offered in the enrollee's hearing care plan contract.
"Health insurance coverage" has the meaning given to that
term in Section 5 of the Illinois Health Insurance Portability
and Accountability Act.
"Health insurance issuer" has the meaning given to that
term in Section 5 of the Illinois Health Insurance Portability
and Accountability Act.
"Hearing care benefits" means the covered items or covered
services listed or otherwise covered in the contract or plan
documents for an enrollee's hearing care plan or discounted
hearing care plan.

SB2838 Enrolled - 3 - LRB104 17737 BAB 31168 b
"Hearing care organization" means a health insurance
issuer or administrator formed under the laws of this State or
another state that issues or administers a hearing care plan
or discounted hearing care plan.
"Hearing care plan" means any policy, certificate,
contract, or other plan of health insurance coverage, whether
excepted benefits or any other coverage, that provides
coverage for covered items and covered services.
"Hearing instrument professional" means a person who is
licensed in this State as an audiologist, a hearing instrument
dispenser, or a physician.
"Manufacturer" means the legal person, including any
business entity or other form of organization, that
manufactures and distributes hearing aids, earmolds, domes or
inserts, assistive listening devices, and hearing aid supplies
and accessories.
"Noncovered items and services" means items and services
that are not funded or discounted by the enrollee's hearing
care plan or discounted hearing care plan and where the
enrollee is fully responsible for the cost of the item or
service.
"Prescription hearing aid" means any instrument or device,
including an instrument or device dispensed pursuant to a
prescription or order, that is designed, intended, or offered
for the purpose of improving a person's hearing and any parts,
attachments, or accessories, including earmolds.

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"Prescription hearing aid" does not include batteries,
cords, and individual or group auditory training devices and
any instrument or device used by a public utility in providing
telephone or other communication services.
"Routine hearing care services" means services that lack
medical necessity, such as pass or fail hearing screenings,
that are used to determine the need for additional diagnostic
hearing testing.
"Subcontractor" means any company, group, or third-party
entity, including agents, servants, partially owned or wholly
owned subsidiaries, and controlled organizations, that the
hearing care organization contracts with to supply items or
service for a hearing instrument professional or enrollee to
fulfill the benefit plan of a hearing care plan or discounted
hearing care plan.
(b) No hearing care organization that is an issuer or
administrator of a hearing care plan or discounted hearing
care plan issued, delivered, amended, or renewed on or after
the effective date of this amendatory Act of the 104th General
Assembly shall issue or renew a contract that requires a
hearing instrument professional, as a condition of
participation in the hearing care plan or discounted hearing
care plan, to provide items or services to an enrollee at a fee
set by the hearing care plan or discounted hearing care plan
unless the items and services are covered items or covered
services under the hearing care plan or discounted hearing

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care plan.
(c) A hearing instrument professional who chooses not to
accept as payment an amount set by a hearing care plan or
discounted hearing care plan for items and services that are
not covered by the hearing care plan or discounted hearing
care plan shall:
(1) post, in a conspicuous place, a notice stating the
following: "IMPORTANT: This hearing instrument
professional does not accept the fee schedule set by your
hearing care plan for hearing care items and services that
are not covered benefits under your plan, when the item or
service is provided prior to the hearing aid fitting,
after one year following the initial fitting of the
hearing aids, or after all of the allowed service visits
are exhausted. In these cases, the hearing instrument
professional may charge his or her usual and customary
fees for those items and services. This hearing instrument
professional will provide you with an estimated cost for
each noncovered item or service in accordance with the No
Surprises Act."; or
(2) provide the information required under paragraph
(1) in a document provided by the hearing instrument
professional to the patient.
(d) Hearing care benefits must be communicated in writing
by the hearing care organization to an enrollee, prospective
enrollee, and the hearing instrument professional. Covered

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items and services subject to de minimis reimbursement are not
required to be listed in this communication. Noncovered items
and noncovered services must be identified in the hearing care
plan's marketing materials, contract, and plan documents.
(e) No hearing care organization or its officers,
directors, agents, and employees may represent a discount
hearing care benefit as a funded hearing care benefit. A
hearing care organization must clearly list and document, in
the schedule of benefits and in marketing materials and plan
documents, the specific cost sharing amounts to hearing care
benefits provided by both in-network and out-of-network
providers of a hearing care plan or, in the case of a
discounted hearing care plan, the specific discounted amounts
for the discount hearing care benefits provided by preferred
providers.
(f) A hearing care plan or discounted hearing care plan
may provide hearing care benefits that include routine hearing
care services and medically necessary diagnostic hearing
services in accordance with guidance promulgated by the
Centers for Medicare and Medicaid Services. If hearing care
benefits or discount hearing care benefits include routine
hearing testing for the purpose of fitting or modifying a
hearing aid, the hearing instrument professional shall be
reimbursed, by the hearing care organization, by the enrollee,
or by both, as applicable under the terms of the plan, for the
costs of performing the testing regardless of whether the

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enrollee proceeds with the purchase of a prescription hearing
aid.
(g) If a hearing care organization is owned or operated,
in whole or in part, by a hearing aid manufacturer and that
manufacturer offers prescription hearing aids within the
hearing care benefits of a hearing care plan or discounted
hearing care plan, that hearing care organization must
disclose, on its websites for enrollees or potential
enrollees, in its marketing communications, and in its
benefits or plan documents, its ownership or operational
interest and specify which prescription hearing aids are
available within the hearing care plan or discounted hearing
care plan it issues or administers.
(h) The provisions of this Section apply to any
subcontractors used by a hearing care organization to supply
items or services to a hearing instrument professional.
(215 ILCS 5/370u new)
Sec. 370u. Hearing care plans and discounted hearing care
plans. All administrators of hearing care plans or discounted
hearing care plans must comply with Section 356z.88 of this
Code.
(215 ILCS 5/511.119 new)
Sec. 511.119. Hearing care plans. All administrators of
hearing care plans must comply with Section 356z.88 of this

SB2838 Enrolled - 8 - LRB104 17737 BAB 31168 b
Code.
Section 10. The Health Maintenance Organization Act is
amended by changing Section 5-3 as follows:
(215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
Sec. 5-3. Illinois 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, 143.31, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
155.49, 352c, 355.2, 355.3, 355.6, 355.7, 355b, 355c, 356f,
356g, 356g.5-1, 356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2,
356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
356z.18, 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24,
356z.25, 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32,
356z.33, 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39,
356z.40, 356z.40a, 356z.41, 356z.44, 356z.45, 356z.46,
356z.47, 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54,
356z.55, 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61,
356z.62, 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68,
356z.69, 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75,
356z.76, 356z.77, 356z.78, 356z.79, 356z.80, 356z.81, 356z.82,
356z.83, 356z.84, 356z.85, 356z.88, 364, 364.01, 364.3, 367.2,
367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370a, 370c,

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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;

SB2838 Enrolled - 10 - LRB104 17737 BAB 31168 b
(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

SB2838 Enrolled - 11 - LRB104 17737 BAB 31168 b
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

SB2838 Enrolled - 12 - LRB104 17737 BAB 31168 b
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

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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. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
103-123, eff. 1-1-24; 103-154, eff. 6-30-23; 103-420, eff.
1-1-24; 103-426, eff. 8-4-23; 103-445, eff. 1-1-24; 103-551,
eff. 8-11-23; 103-605, eff. 7-1-24; 103-618, eff. 1-1-25;
103-649, eff. 1-1-25; 103-656, eff. 1-1-25; 103-700, eff.
1-1-25; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-753,
eff. 8-2-24; 103-758, eff. 1-1-25; 103-777, eff. 8-2-24;
103-808, eff. 1-1-26; 103-914, eff. 1-1-25; 103-918, eff.
1-1-25; 103-1024, eff. 1-1-25; 104-1, eff. 6-9-25; 104-28,
eff. 1-1-26; 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73,
eff. 1-1-26; 104-98, eff. 1-1-26; 104-289, eff. 1-1-26;
104-324, eff. 1-1-26; 104-334, eff. 8-15-25; 104-379, eff.
1-1-26; 104-417, eff. 8-15-25; revised 11-21-25.)

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Section 15. The Limited Health Service Organization Act is
amended by changing Section 4003 as follows:
(215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
Sec. 4003. Illinois Insurance Code provisions. Limited
health service organizations shall be subject to the
provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151, 152, 153,
154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 352c,
355.2, 355.3, 355b, 355d, 356m, 356q, 356v, 356z.4, 356z.4a,
356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.32,
356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 356z.71,
356z.73, 356z.74, 356z.75, 356z.79, 356z.80, 356z.81, 356z.83,
356z.84, 356z.85, 356z.88, 364.3, 368a, 370a, 401, 401.1, 402,
403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and Articles
IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and
XXXIIB of the Illinois Insurance Code. Nothing in this Section
shall require a limited health care plan to cover any service
that is not a limited health service. For purposes of the
Illinois Insurance Code, except for Sections 444 and 444.1 and
Articles XIII and XIII 1/2, limited health service
organizations in the following categories are deemed to be
domestic companies:
(1) a corporation under the laws of this State; or

SB2838 Enrolled - 15 - LRB104 17737 BAB 31168 b
(2) a corporation organized under the laws of another
state, 30% or more of the enrollees of which are residents
of this State, except a corporation subject to
substantially the same requirements in its state of
organization as is a domestic company under Article VIII
1/2 of the Illinois Insurance Code.
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, eff.
1-1-24; 103-605, eff. 7-1-24; 103-649, eff. 1-1-25; 103-656,
eff. 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24;
103-751, eff. 8-2-24; 103-758, eff. 1-1-25; 103-832, eff.
1-1-25; 103-1024, eff. 1-1-25; 104-1, eff. 6-9-25; 104-42,
eff. 8-1-25; 104-73, eff. 1-1-26; 104-98, eff. 1-1-26;
104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-334, eff.
8-15-25; 104-379, eff. 1-1-26; 104-417, eff. 8-15-25; revised
11-21-25.)
Section 99. Effective date. This Act takes effect January
1, 2027.